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NPI Code Detail

MEDICARE: TAMARA RAHEEM

MEDICARE:   TAMARA  RAHEEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystB9363836CA

General Provider Information

NPI Number : 1255681359
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA RAHEEM
Provider Business Mailing Address
First Line : 720 W CHEYENNE AVE STE 30
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7817
Country : US
Telephone Number : 702-487-5665
Fax Number :
Provider Business Practice Location Address
First Line : 720 W CHEYENNE AVE STE 30
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7817
Country : US
Telephone Number : 702-487-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2012
Last Update Date : 09/16/2012

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Directions to “ TAMARA RAHEEM ” Practice Location

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