Healthcare Provider Details

I. General information

NPI: 1154866465
Provider Name (Legal Business Name): SHANAZ HATIFI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 TECH CENTER DR
SACRAMENTO CA
95826-2563
US

IV. Provider business mailing address

210 SUTTON WAY APT 220
GRASS VALLEY CA
95945-4188
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-6400
  • Fax:
Mailing address:
  • Phone: 510-393-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberD2101371
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: