Provider Demographics
NPI:1336871094
Name:CONNOR, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:CONNOR
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:PO BOX 631277
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1277
Mailing Address - Country:US
Mailing Address - Phone:858-428-0222
Mailing Address - Fax:858-345-3341
Practice Address - Street 1:4200 ROCKLIN RD STE 11B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2860
Practice Address - Country:US
Practice Address - Phone:858-428-0222
Practice Address - Fax:858-345-3341
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician