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General NPI Number Information
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NPI Number | 1093965055
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Entity Type | Individual
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Provider Name | SHIVA SARABI PSYD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 366 SAN MIGUEL DR SUITE 209
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7817
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Country | US
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Telephone | 949-563-4855
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 455
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City | BREA
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State | CA
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Zip | 92822-0455
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY26765
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License Number State | CA
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