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NPI Code Detail

MEDICARE: MITRA - SHAHBANI-YEGANEH

MEDICARE: MITRA - SHAHBANI-YEGANEH
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1437287257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITRA - SHAHBANI-YEGANEH
Provider Business Mailing Address
First Line : 2121 E 1ST ST UNIT 203
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-2403
Country : US
Telephone Number : 562-434-1126
Fax Number : 562-434-1126
Provider Business Practice Location Address
First Line : 2183 FAIRVIEW RD STE 100
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-5671
Country : US
Telephone Number : 949-515-5440
Fax Number : 949-515-5444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 05/18/2021

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Directions to “ MITRA - SHAHBANI-YEGANEH ” Practice Location

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