Healthcare Provider Details

I. General information

NPI: 1609446723
Provider Name (Legal Business Name): SINNA MAHJOOB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE STE 102
FRESNO CA
93711-3229
US

IV. Provider business mailing address

3433 W SHAW AVE STE 102
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-374-3990
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: