Provider Demographics
NPI:1518929520
Name:SAAVEDRA, ROSALIA (OD)
Entity Type:Individual
Prefix:
First Name:ROSALIA
Middle Name:
Last Name:SAAVEDRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PARROTT ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4813
Mailing Address - Country:US
Mailing Address - Phone:510-483-4770
Mailing Address - Fax:510-351-5008
Practice Address - Street 1:157 PARROTT ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4813
Practice Address - Country:US
Practice Address - Phone:510-483-4770
Practice Address - Fax:510-351-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10781T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ896AOtherPTAN
CACJ896AMedicare PIN
CAP00934490Medicare PIN