Healthcare Provider Details

I. General information

NPI: 1114870557
Provider Name (Legal Business Name): VANSH WALIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 HEARTLAND CIR
BRENTWOOD CA
94513-2195
US

IV. Provider business mailing address

2079 HEARTLAND CIR
BRENTWOOD CA
94513-2195
US

V. Phone/Fax

Practice location:
  • Phone: 925-436-0804
  • Fax:
Mailing address:
  • Phone: 925-436-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: