Healthcare Provider Details

I. General information

NPI: 1396264941
Provider Name (Legal Business Name): SHIRIN MOSTOFI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W. LA VETA AVE
ORANGE CA
92868
US

IV. Provider business mailing address

1201 W. LA VETA AVE
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8262
  • Fax: 855-246-2329
Mailing address:
  • Phone: 714-509-8262
  • Fax: 855-246-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: