Healthcare Provider Details

I. General information

NPI: 1891422127
Provider Name (Legal Business Name): DAYNA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 CALLE AVANZADO
SAN CLEMENTE CA
92673-6351
US

IV. Provider business mailing address

1319 CALLE AVANZADO
SAN CLEMENTE CA
92673-6351
US

V. Phone/Fax

Practice location:
  • Phone: 949-272-6146
  • Fax:
Mailing address:
  • Phone: 949-272-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: