Provider Demographics
NPI:1770232092
Name:SHARIFF, JADE AHMAD
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:AHMAD
Last Name:SHARIFF
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 1:2155 CHICAGO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2209
Mailing Address - Country:US
Mailing Address - Phone:951-357-2494
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:2155 CHICAGO AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2209
Practice Address - Country:US
Practice Address - Phone:951-357-6925
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician