Provider Demographics
NPI:1568822708
Name:ISLAM, TAMIMA
Entity Type:Individual
Prefix:
First Name:TAMIMA
Middle Name:
Last Name:ISLAM
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 1:3236 CLEAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0408
Mailing Address - Country:US
Mailing Address - Phone:909-214-2141
Mailing Address - Fax:
Practice Address - Street 1:3236 CLEAR LAKE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-0408
Practice Address - Country:US
Practice Address - Phone:909-214-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst