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NPI Code Detail

MEDICARE: MR. NATHAN FIRAS KAKISH

MEDICARE: MR. NATHAN FIRAS KAKISH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1922956614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHAN FIRAS KAKISH
Provider Business Mailing Address
First Line : 45008 CARLA CT
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-1526
Country : US
Telephone Number : 951-415-6776
Fax Number :
Provider Business Practice Location Address
First Line : 45008 CARLA CT
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-1526
Country : US
Telephone Number : 951-415-6776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ MR. NATHAN FIRAS KAKISH ” Practice Location

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