Provider Demographics
NPI:1841676475
Name:SAAVEDRA, MIRNA
Entity type:Individual
Prefix:MRS
First Name:MIRNA
Middle Name:
Last Name:SAAVEDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MIRNA
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1358 PALOMAR PL
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1358 PALOMAR PL
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3565
Practice Address - Country:US
Practice Address - Phone:760-224-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002671363LW0102X
CA235741367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health