MEDICARE: REACH BEHAVIORAL MEDICINE INC.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	20A9369	CA
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician	20A9369	CA
3	207R00000X	Internal Medicine Physician	A48224	CA
4	207RA0401X	Addiction Medicine (Internal Medicine) Physician	A48224	CA
5	2084P0800X	Psychiatry Physician	A34558	CA
6	2084P0802X	Addiction Psychiatry Physician	A34558	CA

General Provider Information

NPI Number	:	1831607589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACH BEHAVIORAL MEDICINE INC.

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91031-0218
Country	:	US
Telephone Number	:	951-529-7890
Fax Number	:	323-553-2789

Provider Business Practice Location Address
First Line	:	3304 W BURBANK BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2230
Country	:	US
Telephone Number	:	323-351-6136
Fax Number	:	323-553-2789

Authorized Official
Title or Position	:	CEO
Name	:	DR. ALIX NASSIRI
Credential	:	D.O.
Telephone Number	:	951-529-7890

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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