Healthcare Provider Details

I. General information

NPI: 1851128870
Provider Name (Legal Business Name): SHAGHAYEGH HABIBI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 WYSTONE AVE UNIT 6
RESEDA CA
91335-7611
US

IV. Provider business mailing address

6521 WYSTONE AVE UNIT 6
RESEDA CA
91335-7611
US

V. Phone/Fax

Practice location:
  • Phone: 818-307-6020
  • Fax:
Mailing address:
  • Phone: 818-307-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAGHAYEGH HABIBI
Title or Position: CEO
Credential: PHD
Phone: 818-307-6020