Provider Demographics
NPI:1841714128
Name:SAHAGUN, ISELA
Entity type:Individual
Prefix:
First Name:ISELA
Middle Name:
Last Name:SAHAGUN
Suffix:
Gender:
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 5715
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-0715
Mailing Address - Country:US
Mailing Address - Phone:510-467-4250
Mailing Address - Fax:
Practice Address - Street 1:11 EMBARCADERO W STE 136
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4500
Practice Address - Country:US
Practice Address - Phone:510-467-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2025-03-14
Deactivation Date:2019-08-27
Deactivation Code:
Reactivation Date:2019-09-07
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
CA98039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program