Healthcare Provider Details

I. General information

NPI: 1669905212
Provider Name (Legal Business Name): JASHLEEN S PITCHAIMALAI M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASHLEEN S LAL

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 W TENNYSON RD APT 103
HAYWARD CA
94544-5139
US

IV. Provider business mailing address

983 W TENNYSON RD APT 103
HAYWARD CA
94544-5139
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-0918
  • Fax:
Mailing address:
  • Phone: 510-305-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42478
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: