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NPI Code Detail

MEDICARE: DR. SHAJI HAQ PH.D., BCBA, NCSP

MEDICARE: DR. SHAJI HAQ PH.D., BCBA, NCSP
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 Analyst1-16-21644GA

General Provider Information

NPI Number : 1437604071
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHAJI HAQ PH.D., BCBA, NCSP
Provider Business Mailing Address
First Line : 1063 MCGAW AVE STE 100
Second Line :
City : IRVINE
State : CA
Zip : 92614-5554
Country : US
Telephone Number : 714-487-2974
Fax Number :
Provider Business Practice Location Address
First Line : 1063 MCGAW AVE STE 100
Second Line :
City : IRVINE
State : CA
Zip : 92614-5554
Country : US
Telephone Number : 714-487-2974
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2016
Last Update Date : 10/27/2020

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