Provider Demographics
NPI:1437921178
Name:JONES, SAGIRAH THANDIWEH
Entity Type:Individual
Prefix:
First Name:SAGIRAH
Middle Name:THANDIWEH
Last Name:JONES
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 1:6630 INDEPENDENCE AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2995
Mailing Address - Country:US
Mailing Address - Phone:562-503-5643
Mailing Address - Fax:
Practice Address - Street 1:6630 INDEPENDENCE AVE APT 207
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2995
Practice Address - Country:US
Practice Address - Phone:562-503-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty