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General NPI Number Information
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NPI Number | 1932575354
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Entity Type | Individual
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Provider Name | SHABNAM MOEINI-FERDOSI
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 5647 GATEWAY ROAD 105
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City | CARLSBAD
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State | CA
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Zip | 92009
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Country | US
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Telephone | 760-410-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 2647 GATEWAY RD STE 105
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City | CARLSBAD
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State | CA
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Zip | 92009-1757
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Country | US
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Telephone | 858-205-7280
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | RPE 930
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License Number State | CA
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