Provider Demographics
NPI:1326539529
Name:MAITHRIPALA, SAVANIE (MSC LCGC)
Entity Type:Individual
Prefix:
First Name:SAVANIE
Middle Name:
Last Name:MAITHRIPALA
Suffix:
Gender:F
Credentials:MSC LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2518
Mailing Address - Country:US
Mailing Address - Phone:312-866-5602
Mailing Address - Fax:
Practice Address - Street 1:499 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2518
Practice Address - Country:US
Practice Address - Phone:312-866-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246000235170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS