Provider Demographics
NPI:1376967174
Name:WILLIAMS, SAVANNAH ALYSSE (LPT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ALYSSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 W POZO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:93453-9620
Mailing Address - Country:US
Mailing Address - Phone:805-610-0390
Mailing Address - Fax:
Practice Address - Street 1:2340 W POZO RD
Practice Address - Street 2:
Practice Address - City:SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:93453-9620
Practice Address - Country:US
Practice Address - Phone:805-610-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36870167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician