Healthcare Provider Details

I. General information

NPI: 1124954821
Provider Name (Legal Business Name): ARSHEEN AWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8617 TENAYA CT
STOCKTON CA
95212-3468
US

IV. Provider business mailing address

1861 ERICKSON CIR
STOCKTON CA
95206-6356
US

V. Phone/Fax

Practice location:
  • Phone: 209-483-2411
  • Fax:
Mailing address:
  • Phone: 209-483-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-293472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: