Healthcare Provider Details

I. General information

NPI: 1770616005
Provider Name (Legal Business Name): JEANINE F SACHS MS., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13625 ADRIAN ST.
POWAY CA
92064
US

IV. Provider business mailing address

13625 ADRIAN ST.
POWAY CA
92064
US

V. Phone/Fax

Practice location:
  • Phone: 858-231-3489
  • Fax: 858-679-9390
Mailing address:
  • Phone: 858-231-3489
  • Fax: 858-679-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number34188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: