Basic Information
| Provider Information | |||||||||
| NPI: | 1861789810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAUCEDO | ||||||||
| FirstName: | HELEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 642 FRASER AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900223122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232467120 | ||||||||
| FaxNumber: | 3233460966 | ||||||||
| Practice Location | |||||||||
| Address1: | 3303 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900312803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234826332 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.