Individual
AHMED AWAD QASIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11545 DOVERWOOD DR, RIVERSIDE, CA 92505-3205
(650) 452-2554
Mailing address
11545 DOVERWOOD DR, RIVERSIDE, CA 92505-3205
(650) 452-2554
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
331881116
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331881116
CDSS
CA
Enumeration date
03/01/2021
Last updated
03/16/2021
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