Healthcare Provider Details

I. General information

NPI: 1831607589
Provider Name (Legal Business Name): REACH BEHAVIORAL MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 W BURBANK BLVD
BURBANK CA
91505-2230
US

IV. Provider business mailing address

PO BOX 218
SOUTH PASADENA CA
91031-0218
US

V. Phone/Fax

Practice location:
  • Phone: 323-351-6136
  • Fax: 323-553-2789
Mailing address:
  • Phone: 951-529-7890
  • Fax: 323-553-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20A9369
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number20A9369
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48224
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA48224
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA34558
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA34558
License Number StateCA

VIII. Authorized Official

Name: DR. ALIX NASSIRI
Title or Position: CEO
Credential: D.O.
Phone: 951-529-7890