Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003963489 |
---|---|
Provider Name | Mr. Arif Khwaja |
First Address | Artesia, CA 90701-4249 |
Second Address | Ontario, CA 91762-3262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |