Healthcare Provider Details

I. General information

NPI: 1851069041
Provider Name (Legal Business Name): SHIMA DAFTARIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date: 09/27/2022
Reactivation Date: 10/06/2022

III. Provider practice location address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

IV. Provider business mailing address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax:
Mailing address:
  • Phone: 562-863-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: