Healthcare Provider Details

I. General information

NPI: 1013057041
Provider Name (Legal Business Name): NEGAR SHEKARABI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 SAN JOAQUIN HILLS RD
NEWPORT BEACH CA
92660-6507
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 300
ORANGE CA
92868-3219
US

V. Phone/Fax

Practice location:
  • Phone: 949-386-5700
  • Fax: 833-623-5063
Mailing address:
  • Phone: 714-456-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: