1083900070 NPI number — DR. JACEY SAUCEDO COY PSYD, LMFT

Table of content: DR. JACEY SAUCEDO COY PSYD, LMFT (NPI 1083900070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083900070 NPI number — DR. JACEY SAUCEDO COY PSYD, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COY
Provider First Name:
JACEY
Provider Middle Name:
SAUCEDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083900070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3434 GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMON GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91945-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-281-3706
Provider Business Mailing Address Fax Number:
619-281-3714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3434 GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMON GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91945-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-281-3706
Provider Business Practice Location Address Fax Number:
619-281-3714
Provider Enumeration Date:
06/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT 53665 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)