Healthcare Provider Details

I. General information

NPI: 1417846908
Provider Name (Legal Business Name): TAHMID AHMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15250 AVENUE OF SCIENCE
SAN DIEGO CA
92128-3406
US

IV. Provider business mailing address

15250 AVENUE OF SCIENCE
SAN DIEGO CA
92128-3406
US

V. Phone/Fax

Practice location:
  • Phone: 858-521-2800
  • Fax:
Mailing address:
  • Phone: 858-521-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: