Healthcare Provider Details

I. General information

NPI: 1528522158
Provider Name (Legal Business Name): HAMNA TAYYAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SPRUCE ST STE A
RIVERSIDE CA
92507-2410
US

IV. Provider business mailing address

1405 SPRUCE ST STE A
RIVERSIDE CA
92507-2410
US

V. Phone/Fax

Practice location:
  • Phone: 951-396-6870
  • Fax: 866-462-6824
Mailing address:
  • Phone: 951-396-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57221
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: