Healthcare Provider Details

I. General information

NPI: 1205357456
Provider Name (Legal Business Name): MASOUMEH NOURSHAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

324 S BEVERLY DR STE 1057
BEVERLY HILLS CA
90212-4822
US

V. Phone/Fax

Practice location:
  • Phone: 805-582-4075
  • Fax: 805-582-4075
Mailing address:
  • Phone: 747-302-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: