Healthcare Provider Details

I. General information

NPI: 1770671869
Provider Name (Legal Business Name): SANDRA ANN SAGARNAGA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR # 120
ORANGE CA
92868-3504
US

IV. Provider business mailing address

4000 W METROPOLITAN DR # 120
ORANGE CA
92868-3504
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax: 714-480-6613
Mailing address:
  • Phone: 714-972-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: