Healthcare Provider Details

I. General information

NPI: 1588556302
Provider Name (Legal Business Name): SARAH CHAMPASSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32326 CLINTON KEITH RD STE 201
WILDOMAR CA
92595-7317
US

IV. Provider business mailing address

16255 VENTURA BLVD STE 900
ENCINO CA
91436-2317
US

V. Phone/Fax

Practice location:
  • Phone: 951-528-2148
  • Fax: 858-649-6012
Mailing address:
  • Phone: 800-434-8923
  • Fax: 858-649-6012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2856739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: