=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013476001
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAGRARIO PURECO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2019
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12361 LEWIS ST STE 204
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92840-4677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-285-8252
-----------------------------------------------------
Fax | 818-273-1831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7141 WOODLEY AVE
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-3932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-285-8252
-----------------------------------------------------
Fax | 818-273-1831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------