Individual
NILOUFAR AKHAVAN TABIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
90 S MAIN ST, MIDDLETOWN, CT 06457-3649
(860) 358-6300
Mailing address
PO BOX 5157, MODESTO, CA 95352-5157
(209) 572-2589
(209) 572-1461
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/07/2018
Last updated
04/04/2023
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