Provider Demographics
NPI:1548367436
Name:SAENZ, LUCY MAYELA (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:MAYELA
Last Name:SAENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2640
Mailing Address - Country:US
Mailing Address - Phone:714-547-4411
Mailing Address - Fax:714-547-4222
Practice Address - Street 1:1215 E 17TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2640
Practice Address - Country:US
Practice Address - Phone:714-547-4411
Practice Address - Fax:714-547-4222
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56461208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A564611Medicaid
CAA56461Medicare ID - Type Unspecified
G69439Medicare UPIN