Provider Demographics
NPI:1023853595
Name:MOHAMMADI, TAHEREH
Entity type:Individual
Prefix:
First Name:TAHEREH
Middle Name:
Last Name:MOHAMMADI
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 1:8089 SUNRISE EAST WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7297
Mailing Address - Country:US
Mailing Address - Phone:281-917-7646
Mailing Address - Fax:
Practice Address - Street 1:8089 SUNRISE EAST WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7297
Practice Address - Country:US
Practice Address - Phone:281-917-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician