Healthcare Provider Details

I. General information

NPI: 1265385496
Provider Name (Legal Business Name): MONA BOURBOUR SHIRAZI KORDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA SHIRAZI NP

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23832 ROCKFIELD BLVD STE 120
LAKE FOREST CA
92630-2870
US

IV. Provider business mailing address

5242 MOLINO
IRVINE CA
92618-4833
US

V. Phone/Fax

Practice location:
  • Phone: 714-769-6090
  • Fax:
Mailing address:
  • Phone: 949-870-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: