Healthcare Provider Details

I. General information

NPI: 1457298226
Provider Name (Legal Business Name): TARIG ADAM BALLA ABD ALLAH SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7422 GARVEY AVE UNIT 204
ROSEMEAD CA
91770-2974
US

IV. Provider business mailing address

23371 MULHOLLAND DR UNIT 429
WOODLAND HILLS CA
91364-2734
US

V. Phone/Fax

Practice location:
  • Phone: 626-531-6999
  • Fax: 626-531-6998
Mailing address:
  • Phone: 626-531-6999
  • Fax: 626-531-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: