Healthcare Provider Details

I. General information

NPI: 1720916034
Provider Name (Legal Business Name): MARIAH SHANELLE SAAVEDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W COLORADO ST
GLENDALE CA
91204-3650
US

IV. Provider business mailing address

1156 HEARST AVE UNIT C1156
BERKELEY CA
94702-1678
US

V. Phone/Fax

Practice location:
  • Phone: 213-886-3678
  • Fax:
Mailing address:
  • Phone: 505-318-5295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: