Provider Demographics
NPI:1174985295
Name:VERDUGO, SASHA (MA)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:VERDUGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1630
Mailing Address - Country:US
Mailing Address - Phone:619-977-6832
Mailing Address - Fax:
Practice Address - Street 1:5743 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1630
Practice Address - Country:US
Practice Address - Phone:619-977-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst