Healthcare Provider Details

I. General information

NPI: 1679157721
Provider Name (Legal Business Name): STEPHEN A SAVAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S GRAND AVE
SANTA ANA CA
92705-4434
US

IV. Provider business mailing address

1300 S GRAND AVE STE 213
SANTA ANA CA
92705-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-7462
  • Fax:
Mailing address:
  • Phone: 714-567-7462
  • Fax: 714-567-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: