Provider Demographics
NPI:1255863668
Name:SAHAGUN, ELISA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:SAHAGUN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 HARBOR BLVD # 136
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3912
Mailing Address - Country:US
Mailing Address - Phone:619-917-1843
Mailing Address - Fax:949-271-3741
Practice Address - Street 1:17911 SKY PARK CIR
Practice Address - Street 2:SUITE E
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6322
Practice Address - Country:US
Practice Address - Phone:619-917-1843
Practice Address - Fax:949-271-3741
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25384103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst