Provider Demographics
NPI:1265478424
Name:SAUCEDO, JESUS (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 AIRPORT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2020
Mailing Address - Country:US
Mailing Address - Phone:650-240-8198
Mailing Address - Fax:408-328-5695
Practice Address - Street 1:577 AIRPORT BLVD
Practice Address - Street 2:STE 300
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2020
Practice Address - Country:US
Practice Address - Phone:650-240-8122
Practice Address - Fax:408-328-5695
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A560990Medicaid
CA00A560995Medicare PIN