Provider Demographics
NPI:1831607589
Name:REACH BEHAVIORAL MEDICINE INC.
Entity type:Organization
Organization Name:REACH BEHAVIORAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIX
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-529-7890
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-0218
Mailing Address - Country:US
Mailing Address - Phone:951-529-7890
Mailing Address - Fax:323-553-2789
Practice Address - Street 1:3304 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2230
Practice Address - Country:US
Practice Address - Phone:323-351-6136
Practice Address - Fax:323-553-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9369207LP2900X, 207LA0401X
CAA48224207R00000X, 207RA0401X
CAA345582084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty