Healthcare Provider Details

I. General information

NPI: 1528996246
Provider Name (Legal Business Name): YASMINE KUDOWOR IBA, QBA, LBA-TX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 HOWELL MOUNTAIN LN
ANTIOCH CA
94531-6212
US

IV. Provider business mailing address

5616 HOWELL MOUNTAIN LN
ANTIOCH CA
94531-6212
US

V. Phone/Fax

Practice location:
  • Phone: 877-296-8222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: