Provider Demographics
NPI:1316071335
Name:SALDANA, LUCIA DEJESUS (PA)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:DEJESUS
Last Name:SALDANA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 CALLE ANACUA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3377
Mailing Address - Country:US
Mailing Address - Phone:956-821-3996
Mailing Address - Fax:
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-583-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03515363A00000X
MSPA036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSQ05577Medicare UPIN
MS970000022Medicare ID - Type UnspecifiedPROVIDER NUMBER