Healthcare Provider Details

I. General information

NPI: 1073225199
Provider Name (Legal Business Name): KURT SAKURADA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9375 ARCHIBALD AVE STE 209
RANCHO CUCAMONGA CA
91730-5702
US

IV. Provider business mailing address

9375 ARCHIBALD AVE STE 209
RANCHO CUCAMONGA CA
91730-5702
US

V. Phone/Fax

Practice location:
  • Phone: 949-668-7004
  • Fax:
Mailing address:
  • Phone: 949-668-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: