MEDICARE: JACLYN SAGUN PH.D.

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
1	103TC0700X	Clinical Psychologist	PSY28693	CA

General Provider Information

NPI Number	:	1770777278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN SAGUN PH.D.

Provider Business Mailing Address
First Line	:	3108 GLENDALE BLVD # 108
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 BAUCHET ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2906
Country	:	US
Telephone Number	:	310-562-5683
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	01/19/2024

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