Healthcare Provider Details

I. General information

NPI: 1336044478
Provider Name (Legal Business Name): SABA MAHMOUDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CHIMES VIEW DR
SOUTH OGDEN UT
84405-1608
US

IV. Provider business mailing address

440 W 1400 N APT 2
LOGAN UT
84341-6404
US

V. Phone/Fax

Practice location:
  • Phone: 818-614-1454
  • Fax:
Mailing address:
  • Phone: 818-614-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: