Healthcare Provider Details

I. General information

NPI: 1174152805
Provider Name (Legal Business Name): SAVANNA LEE HAWLEY LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AJ LEE HAWLEY LVN

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 27TH ST
SAN DIEGO CA
92102-2710
US

IV. Provider business mailing address

892 27TH ST
SAN DIEGO CA
92154-1444
US

V. Phone/Fax

Practice location:
  • Phone: 619-575-4687
  • Fax:
Mailing address:
  • Phone: 619-575-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number702272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: