Healthcare Provider Details

I. General information

NPI: 1558025668
Provider Name (Legal Business Name): SAVANNA THOMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST ATTN: FAMILY MEDICINE RESIDENCY
EUREKA CA
95501-4799
US

IV. Provider business mailing address

1707 GLENDALE DR
MCKINLEYVILLE CA
95519-9210
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: