Provider Demographics
NPI:1871176636
Name:TABAZA, RAGHAD (PSYD)
Entity type:Individual
Prefix:DR
First Name:RAGHAD
Middle Name:
Last Name:TABAZA
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15920 POMONA RINCON RD UNIT 9201
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5558
Mailing Address - Country:US
Mailing Address - Phone:626-374-0779
Mailing Address - Fax:
Practice Address - Street 1:15920 POMONA RINCON RD UNIT 9201
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5558
Practice Address - Country:US
Practice Address - Phone:626-374-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA-103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist