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General NPI Number Information
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NPI Number | 1912769852
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Entity Type | Individual
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Provider Name | AVA BIBI SHAKIB-COCKS ASW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 426 4TH ST
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City | ENCINITAS
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State | CA
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Zip | 92024-3401
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Country | US
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Telephone | 949-632-7302
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Fax |
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Provider Business Mailing Address
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Address Line | 22141 WREN WAY
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City | LAKE FOREST
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State | CA
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Zip | 92630-1863
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Country | US
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Telephone | 949-632-7302
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115853
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License Number State | CA
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