Healthcare Provider Details

I. General information

NPI: 1629262860
Provider Name (Legal Business Name): SHAHNAZ D SADEGHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W MANCHESTER BLVD
INGLEWOOD CA
90301-1656
US

IV. Provider business mailing address

23825 TIARA ST
WOODLAND HILLS CA
91367-2952
US

V. Phone/Fax

Practice location:
  • Phone: 310-412-0879
  • Fax: 310-412-3365
Mailing address:
  • Phone: 818-710-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT111304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: