Healthcare Provider Details

I. General information

NPI: 1457004764
Provider Name (Legal Business Name): ADIB HASHEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 BROOKHOLLOW DR STE 300
SANTA ANA CA
92705-5410
US

IV. Provider business mailing address

1528 BROOKHOLLOW DR STE 300
SANTA ANA CA
92705-5410
US

V. Phone/Fax

Practice location:
  • Phone: 714-733-9051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-63158
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: