Provider Demographics
NPI:1457508640
Name:SAGUN, MARIA TERESA MARTINEZ
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:MARTINEZ
Last Name:SAGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73895 SHADOW MOUNTAIN DR APT 2
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4824
Mailing Address - Country:US
Mailing Address - Phone:760-972-8670
Mailing Address - Fax:
Practice Address - Street 1:73895 SHADOW MOUNTAIN DR APT 2
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4824
Practice Address - Country:US
Practice Address - Phone:760-972-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8597225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant