Healthcare Provider Details

I. General information

NPI: 1427863133
Provider Name (Legal Business Name): NADIA MASHRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 WHISPERING WIND DR
TRACY CA
95377-8119
US

IV. Provider business mailing address

310 SUMMER PHLOX LN
PATTERSON CA
95363-8323
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-7032
  • Fax:
Mailing address:
  • Phone: 209-458-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: