Healthcare Provider Details

I. General information

NPI: 1083539480
Provider Name (Legal Business Name): NADINE TAHANI SAWDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 JURUPA ST
ONTARIO CA
91761-1426
US

IV. Provider business mailing address

1156 SUNSET CT
UPLAND CA
91784-1082
US

V. Phone/Fax

Practice location:
  • Phone: 909-259-5600
  • Fax:
Mailing address:
  • Phone: 909-456-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: