Healthcare Provider Details

I. General information

NPI: 1427970920
Provider Name (Legal Business Name): SPROUT PEDIATRIC BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28884 CAMINO SANTIAGO
WINCHESTER CA
92596-5508
US

IV. Provider business mailing address

28884 CAMINO SANTIAGO
WINCHESTER CA
92596-5508
US

V. Phone/Fax

Practice location:
  • Phone: 925-886-4469
  • Fax: 877-313-3694
Mailing address:
  • Phone: 925-886-4469
  • Fax: 877-313-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARIA TRIXY IGNACIO
Title or Position: OWNER/BCBA
Credential: BCBA
Phone: 206-851-2106