Healthcare Provider Details

I. General information

NPI: 1346521242
Provider Name (Legal Business Name): STEFAN JAMES SHAKIBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

IV. Provider business mailing address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT87666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: