Healthcare Provider Details

I. General information

NPI: 1154191740
Provider Name (Legal Business Name): HOUMAN SHAHRAZ PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 N GRAND AVE
COVINA CA
91724-1016
US

IV. Provider business mailing address

3943 IRVINE BLVD UNIT 2024
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 626-430-2900
  • Fax:
Mailing address:
  • Phone: 949-371-6519
  • Fax: 949-342-7463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: