Healthcare Provider Details

I. General information

NPI: 1588596225
Provider Name (Legal Business Name): IMANI MALIK BELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BUTCHER RD
VACAVILLE CA
95687-5685
US

IV. Provider business mailing address

64 EL TORO CT
FAIRFIELD CA
94533-2233
US

V. Phone/Fax

Practice location:
  • Phone: 707-908-9800
  • Fax:
Mailing address:
  • Phone: 510-290-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: