Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A139156 | CA |
NPI | 1164837191 |
---|---|
Provider Name | Uziel Sauceda |
First Address | Moreno Valley, CA 92555-3927 |
Second Address | Moreno Valley, CA 92555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2014 |
Last Update Date | 21/08/2018 |