Healthcare Provider Details

I. General information

NPI: 1619503646
Provider Name (Legal Business Name): WESSAM FARHAN RABBADY PSYCH ASSOCIATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 BUSINESS CENTER DR STE 112
SAN BERNARDINO CA
92408-3447
US

IV. Provider business mailing address

1845 BUSINESS CENTER DR STE 112
SAN BERNARDINO CA
92408-3447
US

V. Phone/Fax

Practice location:
  • Phone: 909-292-8997
  • Fax:
Mailing address:
  • Phone: 909-292-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSB94028281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-114797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: