Provider Demographics
NPI:1104872787
Name:SAUCEDO, TOMAS (MD)
Entity type:Individual
Prefix:
First Name:TOMAS
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 1:880 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4700
Mailing Address - Country:US
Mailing Address - Phone:626-289-0178
Mailing Address - Fax:626-308-2083
Practice Address - Street 1:880 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4700
Practice Address - Country:US
Practice Address - Phone:626-289-0178
Practice Address - Fax:626-308-2083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB57533Medicare UPIN