Healthcare Provider Details

I. General information

NPI: 1962118265
Provider Name (Legal Business Name): MASTANEH LASHKARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 CAMPUS DR STE 550
IRVINE CA
92612-4694
US

IV. Provider business mailing address

4199 CAMPUS DR STE 550
IRVINE CA
92612-4694
US

V. Phone/Fax

Practice location:
  • Phone: 818-205-4206
  • Fax: 949-509-6599
Mailing address:
  • Phone: 818-205-4206
  • Fax: 949-509-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: