Provider Demographics
NPI:1063962884
Name:SAHAGUN, PERRY
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:SAHAGUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 WESTHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2551
Mailing Address - Country:US
Mailing Address - Phone:909-282-9510
Mailing Address - Fax:
Practice Address - Street 1:5365 WALNUT AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-628-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily