Basic Information
Provider Information
NPI: 1003009689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAUCEDO
FirstName: ROSALYNDA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: B.A, SLPA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 21520 PIONEER BLVD STE 110
Address2:  
City: HAWAIIAN GARDENS
State: CA
PostalCode: 907162604
CountryCode: US
TelephoneNumber: 5628653644
FaxNumber: 5628655244
Practice Location
Address1: 21520 PIONEER BLVD STE 110
Address2:  
City: HAWAIIAN GARDENS
State: CA
PostalCode: 907162604
CountryCode: US
TelephoneNumber: 5628653644
FaxNumber: 5628655244
Other Information
ProviderEnumerationDate: 08/27/2007
LastUpdateDate: 01/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XIMFT 81458CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
2355S0801XSPA1597CAN Speech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant

No ID Information.


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