Healthcare Provider Details

I. General information

NPI: 1780183236
Provider Name (Legal Business Name): SURMEET SANDHU BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 DOXEY DR
SAN JOSE CA
95131-2665
US

IV. Provider business mailing address

2222 CABANA LN
TRACY CA
95377-1113
US

V. Phone/Fax

Practice location:
  • Phone: 951-208-5410
  • Fax:
Mailing address:
  • Phone: 951-208-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00004680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-16-25408
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-38275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: