MEDICARE: YEKTA MOUSSAVIAN

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1740966522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEKTA MOUSSAVIAN

Provider Business Mailing Address
First Line	:	3550 CAMINO DEL RIO N STE 104
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1738
Country	:	US
Telephone Number	:	760-634-1125
Fax Number	:

Provider Business Practice Location Address
First Line	:	2658 DEL MAR HEIGHTS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130
Country	:	US
Telephone Number	:	858-335-3514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	02/11/2026

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Directions to “ YEKTA MOUSSAVIAN ” Practice Location

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