Provider Demographics
NPI:1760767636
Name:SAAVEDRA, JUAN (BUILDER)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:SAAVEDRA
Suffix:
Gender:M
Credentials:BUILDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 HERMISTON ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582
Mailing Address - Country:US
Mailing Address - Phone:956-735-6290
Mailing Address - Fax:
Practice Address - Street 1:526 HERMISTON ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582
Practice Address - Country:US
Practice Address - Phone:956-735-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14273171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14273OtherREGISTERED BUILDER