Healthcare Provider Details

I. General information

NPI: 1164035085
Provider Name (Legal Business Name): SHAAKIRA RAASIKH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 10/27/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S FLOWER ST
ORANGE CA
92868-3415
US

IV. Provider business mailing address

523 N BUTTONWOOD ST
ANAHEIM CA
92805-2226
US

V. Phone/Fax

Practice location:
  • Phone: 714-594-9251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: