Healthcare Provider Details

I. General information

NPI: 1467959197
Provider Name (Legal Business Name): CIERAN SAFERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9821 FAIR OAKS BLVD STE A
FAIR OAKS CA
95628-7050
US

IV. Provider business mailing address

9821 FAIR OAKS BLVD STE A
FAIR OAKS CA
95628-7050
US

V. Phone/Fax

Practice location:
  • Phone: 916-534-7633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: