Healthcare Provider Details

I. General information

NPI: 1659219954
Provider Name (Legal Business Name): JOSE E SAGREDO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 1ST ST
SAN FERNANDO CA
91340-2957
US

IV. Provider business mailing address

8717 LEHIGH AVE
SUN VALLEY CA
91352-2743
US

V. Phone/Fax

Practice location:
  • Phone: 818-256-1124
  • Fax:
Mailing address:
  • Phone: 626-510-4478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: