Healthcare Provider Details

I. General information

NPI: 1801727193
Provider Name (Legal Business Name): SHAHLA HAJIALIASGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CREEK RD APT 114
IRVINE CA
92604-4758
US

IV. Provider business mailing address

22 CREEK RD APT 114
IRVINE CA
92604-4758
US

V. Phone/Fax

Practice location:
  • Phone: 917-945-0206
  • Fax:
Mailing address:
  • Phone: 917-945-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: