Healthcare Provider Details

I. General information

NPI: 1215328133
Provider Name (Legal Business Name): ANTHONY HAMEDI BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 BROOKHOLLOW DR STE 114
SANTA ANA CA
92705-5418
US

IV. Provider business mailing address

1504 BROOKHOLLOW DR STE 114
SANTA ANA CA
92705-5418
US

V. Phone/Fax

Practice location:
  • Phone: 949-214-8976
  • Fax: 949-540-9153
Mailing address:
  • Phone: 949-214-8976
  • Fax: 949-540-9153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-10126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: