Healthcare Provider Details

I. General information

NPI: 1639831779
Provider Name (Legal Business Name): SAVANNAH FAITH BACLIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 MYRA AVE
CYPRESS CA
90630-4569
US

IV. Provider business mailing address

5400 MYRA AVE
CYPRESS CA
90630-4559
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-6400
  • Fax: 714-828-3400
Mailing address:
  • Phone: 714-828-6400
  • Fax: 714-828-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: