Healthcare Provider Details

I. General information

NPI: 1275315889
Provider Name (Legal Business Name): SHAKIBA VAFAI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 MACARTHUR BLVD # 340A
NEWPORT BEACH CA
92660-3009
US

IV. Provider business mailing address

2850 KELVIN AVE APT 241
IRVINE CA
92614-0107
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-3888
  • Fax:
Mailing address:
  • Phone: 949-468-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10230540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: