Provider Demographics
NPI:1770246134
Name:SAUCEDO, RUBEN BARRIOS
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:BARRIOS
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6818 DORIANA ST APT 37
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2029
Mailing Address - Country:US
Mailing Address - Phone:619-847-3675
Mailing Address - Fax:
Practice Address - Street 1:6818 DORIANA ST APT 35
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-2028
Practice Address - Country:US
Practice Address - Phone:760-543-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD7841556OtherDRIVER LICENSE