Provider Demographics
NPI:1780183236
Name:SANDHU, SURMEET (BCBA)
Entity Type:Individual
Prefix:
First Name:SURMEET
Middle Name:
Last Name:SANDHU
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 1:2222 CABANA LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-1113
Mailing Address - Country:US
Mailing Address - Phone:951-208-5410
Mailing Address - Fax:
Practice Address - Street 1:2121 DOXEY DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2665
Practice Address - Country:US
Practice Address - Phone:951-208-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00004680106S00000X
CARBT-16-25408106S00000X
CA1-19-38275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician