Provider Demographics
NPI:1932087293
Name:EXTRAORDINARY ABA
Entity type:Organization
Organization Name:EXTRAORDINARY ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDIQI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-790-2334
Mailing Address - Street 1:705 SIERRA LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7186
Mailing Address - Country:US
Mailing Address - Phone:858-790-2334
Mailing Address - Fax:
Practice Address - Street 1:1475 ISLAND AVE UNIT 3605
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8251
Practice Address - Country:US
Practice Address - Phone:858-790-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-25
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center