Healthcare Provider Details

I. General information

NPI: 1730974585
Provider Name (Legal Business Name): SHOLAY SAHAR SHIRAZI ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGEWOOD AVE STE 300
ORANGE CA
92868-2053
US

IV. Provider business mailing address

2957 W BRIDGEPORT AVE
ANAHEIM CA
92804-2049
US

V. Phone/Fax

Practice location:
  • Phone: 657-291-4177
  • Fax: 714-547-7940
Mailing address:
  • Phone: 714-595-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW129049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: