Healthcare Provider Details

I. General information

NPI: 1700207404
Provider Name (Legal Business Name): SAVANN DUONG-SAUCEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 MARENGO ST STE 109110
LOS ANGELES CA
90033
US

IV. Provider business mailing address

9808 VENICE BLVD STE 700
CULVER CITY CA
90232-6824
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-6041
  • Fax: 323-276-6479
Mailing address:
  • Phone: 310-733-6041
  • Fax: 323-276-6479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29266
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number80238
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: