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NPI Code Detail

MEDICARE: SHABNAM RAZAWI M.A.

MEDICARE: SHABNAM RAZAWI M.A.
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 Analyst6642TX
2103K00000XBehavior Analyst1-20-46792

General Provider Information

NPI Number : 1770935751
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHABNAM RAZAWI M.A.
Provider Business Mailing Address
First Line : 2120 IBERIS CT
Second Line :
City : TRACY
State : CA
Zip : 95376-9219
Country : US
Telephone Number : 925-594-0908
Fax Number :
Provider Business Practice Location Address
First Line : 1000 S FREMONT AVE UNIT 85
Second Line :
City : ALHAMBRA
State : CA
Zip : 91803-8822
Country : US
Telephone Number : 818-940-4335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2016
Last Update Date : 08/06/2024

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