MEDICARE: SHAHEENA GAZIPURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	95221003	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NPF95026845	CA

General Provider Information

NPI Number	:	1174971048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHEENA GAZIPURA

Provider Business Mailing Address
First Line	:	421 N BROOKHURST ST STE 119
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-361-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 N BROOKHURST ST STE 119
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-361-0898
Fax Number	:	714-276-2604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	04/21/2025

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Directions to “ SHAHEENA GAZIPURA ” Practice Location

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