Healthcare Provider Details

I. General information

NPI: 1013868868
Provider Name (Legal Business Name): MONA ZIADEH SHAKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16379 SAN JACINTO ST
FOUNTAIN VALLEY CA
92708-1826
US

IV. Provider business mailing address

16379 SAN JACINTO ST
FOUNTAIN VALLEY CA
92708-1826
US

V. Phone/Fax

Practice location:
  • Phone: 714-791-1161
  • Fax:
Mailing address:
  • Phone: 714-791-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: