Provider Demographics
NPI:1760078158
Name:ROINASHVILI, DAVID (MED, BCBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:ROINASHVILI
Suffix:
Gender:M
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 1:1274 N CRESCENT HEIGHTS BLVD APT 125
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5059
Mailing Address - Country:US
Mailing Address - Phone:929-241-6969
Mailing Address - Fax:
Practice Address - Street 1:1274 N CRESCENT HEIGHTS BLVD APT 125
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5059
Practice Address - Country:US
Practice Address - Phone:929-241-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst