1972548428 NPI number — ISAGANI L. SACULO CRNA

Table of content: ISAGANI L. SACULO CRNA (NPI 1972548428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972548428 NPI number — ISAGANI L. SACULO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SACULO
Provider First Name:
ISAGANI
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1972548428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1503 LANCELOT AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLFFORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79382-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-452-3558
Provider Business Mailing Address Fax Number:
806-745-2337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 28TH ST SUITE 2
Provider Second Line Business Practice Location Address:
SUITE 1C282
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-2104
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2006

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: 367500000X , with the licence number:  AP114739 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 70408009 . This is a "CONSULTEC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 202005978 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149984101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200082440A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182510101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149984100 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 202005978 . This is a "PRESBYTERIAN COMMERCIAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 86408U . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86409U . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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