Healthcare Provider Details

I. General information

NPI: 1154095586
Provider Name (Legal Business Name): ASYAH S ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 N MILLSWEET DR
UPLAND CA
91784-7459
US

IV. Provider business mailing address

16500 VENTURA BLVD STE 414
ENCINO CA
91436-5050
US

V. Phone/Fax

Practice location:
  • Phone: 626-658-2905
  • Fax:
Mailing address:
  • Phone: 818-788-1003
  • 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: