Healthcare Provider Details

I. General information

NPI: 1720508815
Provider Name (Legal Business Name): HANIAH AREF FAKHOURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 UTICA AVEUNU SUITE 259
RANCHO CUCAMONGA CA
91730
US

IV. Provider business mailing address

8300 UTICA AVEUNU SUITE 259
RANCHO CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 909-906-1505
  • Fax:
Mailing address:
  • Phone: 909-906-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: