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General NPI Number Information
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NPI Number | 1558905950
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Entity Type | Individual
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Provider Name | SHAHIN ADAM BAVARSAD BA
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Gender | Male
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 6809 INDIANA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-4221
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Country | US
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Telephone | 866-823-4283
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Fax | 475-235-3169
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Provider Business Mailing Address
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Address Line | 10154 ASHFORD ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3001
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Country | US
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Telephone | 562-507-6861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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