Provider Demographics
NPI:1740623602
Name:PHILIPPEAUX, SAGINE
Entity type:Individual
Prefix:
First Name:SAGINE
Middle Name:
Last Name:PHILIPPEAUX
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 1:2101 N GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2828
Mailing Address - Country:US
Mailing Address - Phone:213-342-5706
Mailing Address - Fax:
Practice Address - Street 1:2115 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2203
Practice Address - Country:US
Practice Address - Phone:323-938-3434
Practice Address - Fax:323-938-3434
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-49936103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst