Healthcare Provider Details

I. General information

NPI: 1841543832
Provider Name (Legal Business Name): AMY SAVAGIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE #210
PASADENA CA
91105-3150
US

IV. Provider business mailing address

137 N LARCHMONT BLVD #186
LOS ANGELES CA
90004-3704
US

V. Phone/Fax

Practice location:
  • Phone: 626-872-4195
  • Fax:
Mailing address:
  • Phone: 626-397-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA118771
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA118771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: