Healthcare Provider Details

I. General information

NPI: 1821912528
Provider Name (Legal Business Name): MANIA KAVYANPOUR AGHDASI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 COLLEGE AVE STE 21
OAKLAND CA
94618-2804
US

IV. Provider business mailing address

268 BUSH ST STE 3039
SAN FRANCISCO CA
94104-3503
US

V. Phone/Fax

Practice location:
  • Phone: 888-362-3970
  • Fax:
Mailing address:
  • Phone: 888-362-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: