Healthcare Provider Details

I. General information

NPI: 1578974366
Provider Name (Legal Business Name): DINNIELLE ELIZABETH SARAVIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 COLOMA ST
PLACERVILLE CA
95667-4406
US

IV. Provider business mailing address

2844 COLOMA ST
PLACERVILLE CA
95667-4406
US

V. Phone/Fax

Practice location:
  • Phone: 530-642-1715
  • Fax: 530-642-2064
Mailing address:
  • Phone: 530-642-1715
  • Fax: 530-642-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: