Healthcare Provider Details

I. General information

NPI: 1013907757
Provider Name (Legal Business Name): EDNA R SAYAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 MILLIKEN AVE STE 360
RANCHO CUCAMONGA CA
91730-6782
US

IV. Provider business mailing address

7777 MILLIKEN AVE STE 360
RANCHO CUCAMONGA CA
91730-6782
US

V. Phone/Fax

Practice location:
  • Phone: 909-944-7099
  • Fax: 909-944-4865
Mailing address:
  • Phone: 909-944-7099
  • Fax: 909-944-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC53302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: