Provider Demographics
NPI:1669960068
Name:SAUCIER, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:SAUCIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 FALLBROOK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1613
Mailing Address - Country:US
Mailing Address - Phone:818-719-0055
Mailing Address - Fax:818-592-0904
Practice Address - Street 1:6342 FALLBROOK AVE STE 102
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1613
Practice Address - Country:US
Practice Address - Phone:818-719-0055
Practice Address - Fax:818-592-0904
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHP00065025247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist