Healthcare Provider Details

I. General information

NPI: 1003773151
Provider Name (Legal Business Name): BEHNOOSH BAHRAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SAN PABLO AVE
PINOLE CA
94564-2077
US

IV. Provider business mailing address

4884 SAN PABLO DAM RD APT A
EL SOBRANTE CA
94803-3206
US

V. Phone/Fax

Practice location:
  • Phone: 510-779-2334
  • Fax:
Mailing address:
  • Phone: 510-847-8540
  • 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: