1174184972 NPI number — SAUDE CONSULTING SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174184972 NPI number — SAUDE CONSULTING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAUDE CONSULTING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174184972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2452 N TEAKWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92377-4247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-875-1591
Provider Business Mailing Address Fax Number:
909-875-1591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15428 CIVIC DR STE 245
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92392-2383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-881-3289
Provider Business Practice Location Address Fax Number:
760-881-3290
Provider Enumeration Date:
06/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
ALEIDA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-881-3289

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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