Healthcare Provider Details

I. General information

NPI: 1982380671
Provider Name (Legal Business Name): SAGE REZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17752 SKY PARK CIR STE 140
IRVINE CA
92614-4469
US

IV. Provider business mailing address

21306 BEACH BLVD # V203
HUNTINGTON BEACH CA
92648-5732
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-5577
  • Fax:
Mailing address:
  • Phone: 714-833-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: