Healthcare Provider Details

I. General information

NPI: 1902530017
Provider Name (Legal Business Name): INAARA JIVANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18130 TALAVERA RDG APT 319
SAN ANTONIO TX
78257-1459
US

IV. Provider business mailing address

18130 TALAVERA RDG APT 319
SAN ANTONIO TX
78257-1459
US

V. Phone/Fax

Practice location:
  • Phone: 210-685-6490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71106
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-218294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: