NPIMap

Organization Active NPI

Saucedo Detal Corporation

  • Clinic/Center
  • Pomona, CA
National Provider Identifier
1578854246
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
56687 Issued in CA
Legal business name
SAUCEDO DETAL CORPORATION
Practice address
180 E Mission Blvd Ste a
Pomona, CA 91766-1843
Phone
(909) 623-5278
Fax
(909) 623-5270
NPI assigned
Apr 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sergio P Saucedo, DDS
Title
Ceo
Phone
(909) 623-5278

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 56687 CA Primary

Addresses

Primary practice location

180 E Mission Blvd Ste a
Pomona, CA 91766-1843

Mailing address

180 E Mission Blvd Ste a
Pomona, CA 91766-1843
Phone (909) 623-5278

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1578854246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E MISSION BLVD STE A",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661843",
            "telephone_number": "909-623-5278",
            "fax_number": "909-623-5270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E MISSION BLVD STE A",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661843",
            "telephone_number": "909-623-5278",
            "fax_number": "909-623-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAUCEDO DETAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "SAUCEDO",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-623-5278",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "56687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.