Provider Demographics
NPI:1992563100
Name:MIQDADI, RADIA L
Entity type:Individual
Prefix:
First Name:RADIA
Middle Name:L
Last Name:MIQDADI
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 1:6484 BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 LOTISSEMENT AL MOUNTAZAH AIN DIAB
Practice Address - Street 2:
Practice Address - City:CASABLANCA
Practice Address - State:20180
Practice Address - Zip Code:20180
Practice Address - Country:MA
Practice Address - Phone:310-986-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-68877103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst