Healthcare Provider Details

I. General information

NPI: 1497327787
Provider Name (Legal Business Name): SVAGO DENTAL PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 100
PASADENA CA
91105-2565
US

IV. Provider business mailing address

200 E DEL MAR BLVD STE 100
PASADENA CA
91105-2565
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-6344
  • Fax: 626-765-9913
Mailing address:
  • Phone: 626-792-6344
  • Fax: 626-765-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO ECHEVERRY
Title or Position: OWNER
Credential: DDS
Phone: 626-792-6344