Provider Demographics
NPI:1376670471
Name:BISAGA, JEFFREY S (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:BISAGA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 EAST AVE
Mailing Address - Street 2:SUITE 4-C
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1628
Mailing Address - Country:US
Mailing Address - Phone:530-342-3377
Mailing Address - Fax:530-895-0735
Practice Address - Street 1:1430 EAST AVE
Practice Address - Street 2:SUITE 4-C
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1628
Practice Address - Country:US
Practice Address - Phone:530-342-3377
Practice Address - Fax:530-895-0735
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5229103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL52290Medicare ID - Type Unspecified