Provider Demographics
NPI:1639622798
Name:IHUWAN, OGHOR (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:OGHOR
Middle Name:
Last Name:IHUWAN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 HURLEY WAY STE 290
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3221
Mailing Address - Country:US
Mailing Address - Phone:916-905-1699
Mailing Address - Fax:
Practice Address - Street 1:2035 HURLEY WAY STE 290
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3221
Practice Address - Country:US
Practice Address - Phone:916-905-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI1-16-24586103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other