Healthcare Provider Details

I. General information

NPI: 1104730126
Provider Name (Legal Business Name): MS. SABA SIYAHPOOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 POLLARD AVE
FAIR OAKS CA
95628-6052
US

IV. Provider business mailing address

8218 POLLARD AVE
FAIR OAKS CA
95628-6052
US

V. Phone/Fax

Practice location:
  • Phone: 916-579-0114
  • Fax:
Mailing address:
  • Phone: 916-579-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: