Provider Demographics
NPI:1336713429
Name:RAHIMI-DAVIDSON, SAMUEL WARREN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WARREN
Last Name:RAHIMI-DAVIDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9467 KIWI CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5748
Mailing Address - Country:US
Mailing Address - Phone:714-317-6546
Mailing Address - Fax:
Practice Address - Street 1:9467 KIWI CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5748
Practice Address - Country:US
Practice Address - Phone:714-317-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician