Healthcare Provider Details

I. General information

NPI: 1639660871
Provider Name (Legal Business Name): RAHIM JIWANI RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CRENSHAW BLVD STE 125
LOS ANGELES CA
90043-1227
US

IV. Provider business mailing address

4401 CRENSHAW BLVD STE 125
LOS ANGELES CA
90043-1227
US

V. Phone/Fax

Practice location:
  • Phone: 323-291-7100
  • Fax:
Mailing address:
  • Phone: 323-291-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-35213
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: