Provider Demographics
NPI:1588395891
Name:SAUCEDO DONOSO, MARLENE N
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:N
Last Name:SAUCEDO DONOSO
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 1:4337 TANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6622
Mailing Address - Country:US
Mailing Address - Phone:571-278-3870
Mailing Address - Fax:
Practice Address - Street 1:4337 TANEY AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-6622
Practice Address - Country:US
Practice Address - Phone:571-278-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-19
Last Update Date:2022-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty