Provider Demographics
NPI:1326807900
Name:ELASSADI, TASNEEM J
Entity Type:Individual
Prefix:
First Name:TASNEEM
Middle Name:J
Last Name:ELASSADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22365 HAYWORTH CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-5093
Mailing Address - Country:US
Mailing Address - Phone:714-606-7399
Mailing Address - Fax:
Practice Address - Street 1:22365 HAYWORTH CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-5903
Practice Address - Country:US
Practice Address - Phone:714-606-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8393648103K00000X
103K00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst