Provider Demographics
NPI:1962064881
Name:SAUCEDO, JUAN RICARDO (FNP)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RICARDO
Last Name:SAUCEDO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 SEBASTIAN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6066
Mailing Address - Country:US
Mailing Address - Phone:830-513-2230
Mailing Address - Fax:
Practice Address - Street 1:2703 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3433
Practice Address - Country:US
Practice Address - Phone:956-682-9559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily