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NPI Code Detail

MEDICARE: YEGANEH MOUSSELI

MEDICARE: YEGANEH MOUSSELI
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
1106S00000XBehavior Technician
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023743721
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEGANEH MOUSSELI
Provider Business Mailing Address
First Line : DEPT LA 22763 PASADENA
Second Line :
City : PASADENA
State : CA
Zip : 91185-0001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3650 MT DIABLO BLVD
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-3780
Country : US
Telephone Number : 866-523-4268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2022
Last Update Date : 05/19/2026

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Directions to “ YEGANEH MOUSSELI ” Practice Location

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