Provider Demographics
NPI:1982380671
Name:REZNER, SAGE
Entity Type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:REZNER
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 1:1978 MAPLE AVE APT Q
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5593
Mailing Address - Country:US
Mailing Address - Phone:714-833-1379
Mailing Address - Fax:
Practice Address - Street 1:2222 MARTIN STE 170
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1450
Practice Address - Country:US
Practice Address - Phone:949-474-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician