Healthcare Provider Details

I. General information

NPI: 1720262587
Provider Name (Legal Business Name): MS. GOLRIZ SHAFAIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD 708
ENCINO CA
91436
US

IV. Provider business mailing address

16661 VENTURA BLVD 708
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7474
  • Fax: 818-501-8410
Mailing address:
  • Phone: 818-501-7474
  • Fax: 818-501-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC33739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: