Healthcare Provider Details

I. General information

NPI: 1093891020
Provider Name (Legal Business Name): JOHN VINCENT SAAVEDRA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 N. ORANGEWOOD SUITE 101
ORANGE CA
92868
US

IV. Provider business mailing address

1527 S PINE AVE
ONTARIO CA
91762-5435
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-7171
  • Fax: 714-939-7720
Mailing address:
  • Phone: 909-986-0522
  • Fax: 714-939-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: