Provider Demographics
NPI:1568010452
Name:IRYAMI, SANDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:IRYAMI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 S BEVERLY GLEN BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2444
Mailing Address - Country:US
Mailing Address - Phone:310-717-6564
Mailing Address - Fax:
Practice Address - Street 1:2265 S BEVERLY GLEN BLVD APT 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2444
Practice Address - Country:US
Practice Address - Phone:310-717-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-36196103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst