Provider Demographics
NPI:1780228940
Name:SAGAWINIT, CHASE E (BEHAVIORAL TECHNICIA)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:E
Last Name:SAGAWINIT
Suffix:
Gender:M
Credentials:BEHAVIORAL TECHNICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 WARNER AVE # 339
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:714-848-8319
Mailing Address - Fax:714-596-6274
Practice Address - Street 1:2752 WOODLAWN DR STE 5-202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1855
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-19-95582106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician