Healthcare Provider Details

I. General information

NPI: 1740047349
Provider Name (Legal Business Name): SHIMA SHIEHZADEGAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5691
  • Fax: 949-764-4242
Mailing address:
  • Phone: 949-764-5691
  • Fax: 949-764-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02241236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: