Provider Demographics
NPI:1700207404
Name:DUONG-SAUCEDA, SAVANN
Entity Type:Individual
Prefix:
First Name:SAVANN
Middle Name:
Last Name:DUONG-SAUCEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 VENICE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6824
Mailing Address - Country:US
Mailing Address - Phone:310-733-6041
Mailing Address - Fax:323-276-6479
Practice Address - Street 1:1902 MARENGO ST STE 109110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:310-733-6041
Practice Address - Fax:323-276-6479
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29266101YM0800X
80238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health