Provider Demographics
NPI:1104717230
Name:SAVAGE, DESTINY ALEXIS
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ALEXIS
Last Name:SAVAGE
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 1:3865 BROADWAY # 3C
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-3301
Mailing Address - Country:US
Mailing Address - Phone:916-603-9702
Mailing Address - Fax:
Practice Address - Street 1:3865 BROADWAY # 3C42
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3301
Practice Address - Country:US
Practice Address - Phone:916-603-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula