MEDICARE: MARIAH SHANELLE SAAVEDRA

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1720916034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH SHANELLE SAAVEDRA

Provider Business Mailing Address
First Line	:	1156 HEARST AVE UNIT C1156
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1678
Country	:	US
Telephone Number	:	505-318-5295
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 W COLORADO ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-3650
Country	:	US
Telephone Number	:	213-886-3678
Fax Number	:

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

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/11/2026

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