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NPI Code Detail

MEDICARE: SHEIDA VICTORIA BASTANI BA

MEDICARE: SHEIDA VICTORIA BASTANI BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistMPSS-IKEJLQCA
2373H00000XDay Training/Habilitation SpecialistCA

General Provider Information

NPI Number : 1386534378
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEIDA VICTORIA BASTANI BA
Provider Business Mailing Address
First Line : 1224 VINE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90038-1612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1224 VINE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90038-1612
Country : US
Telephone Number : 626-753-5220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2025
Last Update Date : 04/13/2026

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Directions to “ SHEIDA VICTORIA BASTANI BA” Practice Location

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