Healthcare Provider Details

I. General information

NPI: 1184555435
Provider Name (Legal Business Name): BETHANY SAHAGUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CALLE AMANECER
SAN CLEMENTE CA
92673-6214
US

IV. Provider business mailing address

19015 CERRO VILLA DR
VILLA PARK CA
92861-2332
US

V. Phone/Fax

Practice location:
  • Phone: 949-498-5100
  • Fax:
Mailing address:
  • Phone: 951-901-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: