=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073499968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAJWA BURDICK-YAHYA LEP #4666
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1280 SANTA ANITA CT STE 100
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95776-6128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-801-0513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1437 ST LOUIS WAY
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95776-5572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-801-0513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | 4666
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------