Healthcare Provider Details

I. General information

NPI: 1992563100
Provider Name (Legal Business Name): RADIA L MIQDADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 LOTISSEMENT AL MOUNTAZAH AIN DIAB
CASABLANCA 20180
20180
MA

IV. Provider business mailing address

6484 BRANCH CT
EASTVALE CA
92880-0801
US

V. Phone/Fax

Practice location:
  • Phone: 310-986-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: