Provider Demographics
NPI:1790485191
Name:SAAVEDRA, JAN CARLO
Entity Type:Individual
Prefix:
First Name:JAN CARLO
Middle Name:
Last Name:SAAVEDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2603
Mailing Address - Country:US
Mailing Address - Phone:315-515-8331
Mailing Address - Fax:
Practice Address - Street 1:35 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2603
Practice Address - Country:US
Practice Address - Phone:315-515-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11445208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation