Provider Demographics
NPI:1013907757
Name:SAYAT, EDNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:R
Last Name:SAYAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 MILLIKEN AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6782
Mailing Address - Country:US
Mailing Address - Phone:909-944-7099
Mailing Address - Fax:909-944-4865
Practice Address - Street 1:7777 MILLIKEN AVE STE 360
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6782
Practice Address - Country:US
Practice Address - Phone:909-944-7099
Practice Address - Fax:909-944-4865
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53302208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME427610000Medicaid
ME061279OtherBLUE CROSS PROVIDER ID
MEH45921Medicare UPIN