Healthcare Provider Details

I. General information

NPI: 1831759463
Provider Name (Legal Business Name): SHABANA WASEEM HAIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 1ST ST
SANTA ANA CA
92705-4007
US

IV. Provider business mailing address

2101 E 1ST ST
SANTA ANA CA
92705-4007
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-3581
  • Fax: 714-542-2246
Mailing address:
  • Phone: 949-540-0170
  • Fax: 714-542-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: