Provider Demographics
NPI:1568766681
Name:BUITRAGO, SARA JAN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JAN
Last Name:BUITRAGO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JAN
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2921 SANTOS LN APT 2115
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7610
Mailing Address - Country:US
Mailing Address - Phone:510-325-2258
Mailing Address - Fax:
Practice Address - Street 1:1942 EMBARCADERO
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5213
Practice Address - Country:US
Practice Address - Phone:510-832-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
CA1-14-10218103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty