Healthcare Provider Details

I. General information

NPI: 1164114161
Provider Name (Legal Business Name): TASNEEM MOHMED RICHED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 S BROOKHURST ST STE 104
ANAHEIM CA
92804-3510
US

IV. Provider business mailing address

631 S BROOKHURST ST STE 104
ANAHEIM CA
92804-3510
US

V. Phone/Fax

Practice location:
  • Phone: 714-620-8131
  • Fax:
Mailing address:
  • Phone: 714-620-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: