Healthcare Provider Details

I. General information

NPI: 1447989405
Provider Name (Legal Business Name): AMIN AHMAD MOMAND APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

256 W BADILLO ST
COVINA CA
91723-1906
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-9016
  • Fax:
Mailing address:
  • Phone: 626-480-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6762
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: