1972615904 NPI number — MRS. DEANNA BRODKE SAVANT P.T.

Table of content: MRS. DEANNA BRODKE SAVANT P.T. (NPI 1972615904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972615904 NPI number — MRS. DEANNA BRODKE SAVANT P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVANT
Provider First Name:
DEANNA
Provider Middle Name:
BRODKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972615904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3718 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94610-1544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-893-8878
Provider Business Mailing Address Fax Number:
510-893-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3468 MT. DIABLO BLVD
Provider Second Line Business Practice Location Address:
SUITE B110
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94549-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-284-6150
Provider Business Practice Location Address Fax Number:
925-284-6155
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  18730 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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