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NPI Code Detail

MEDICARE: MS. SARA JAN BUITRAGO MS, BCBA

MEDICARE: MS. SARA JAN BUITRAGO MS, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist
2103K00000XBehavior Analyst1-14-10218CA

General Provider Information

NPI Number : 1568766681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SARA JAN BUITRAGO MS, BCBA
Provider Business Mailing Address
First Line : 2921 SANTOS LN APT 2115
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94597-7610
Country : US
Telephone Number : 510-325-2258
Fax Number :
Provider Business Practice Location Address
First Line : 1942 EMBARCADERO
Second Line :
City : OAKLAND
State : CA
Zip : 94606-5213
Country : US
Telephone Number : 510-832-4383
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2011
Last Update Date : 04/29/2015

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