MEDICARE: ALVARO RAFAEL HERNANDEZ SAAVEDRA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	107734	CA

General Provider Information

NPI Number	:	1679200919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVARO RAFAEL HERNANDEZ SAAVEDRA DDS

Provider Business Mailing Address
First Line	:	20739 ELAINE AVE APT 7
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90715-1752
Country	:	US
Telephone Number	:	702-761-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	16071 GOLDENWEST ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3405
Country	:	US
Telephone Number	:	714-536-2383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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