Provider Demographics
NPI:1972548428
Name:SACULO, ISAGANI L (CRNA)
Entity Type:Individual
Prefix:
First Name:ISAGANI
Middle Name:L
Last Name:SACULO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 LANCELOT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3200
Mailing Address - Country:US
Mailing Address - Phone:903-452-3558
Mailing Address - Fax:806-745-2337
Practice Address - Street 1:4315 28TH ST SUITE 2
Practice Address - Street 2:SUITE 1C282
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2507
Practice Address - Country:US
Practice Address - Phone:806-792-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114739367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70408009OtherCONSULTEC
NM202005978Medicaid
TX149984101Medicaid
OK200082440AMedicaid
TX182510101Medicaid
TX149984100OtherFIRSTCARE COMMERCIAL
NM202005978OtherPRESBYTERIAN COMMERCIAL
TX86408UOtherHMO BLUE
TX86409UOtherBC/BS
TXP00325016Medicare ID - Type UnspecifiedRAILROAD
TX8G7743Medicare ID - Type Unspecified