Healthcare Provider Details

I. General information

NPI: 1770198731
Provider Name (Legal Business Name): SARA WAIS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 SERRA WAY
ANTIOCH CA
94509-7371
US

IV. Provider business mailing address

3009 SERRA WAY
ANTIOCH CA
94509-7371
US

V. Phone/Fax

Practice location:
  • Phone: 925-822-4267
  • Fax:
Mailing address:
  • Phone: 925-822-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003030
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: