Provider Information for 1508050204
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MANDANA SHAHOVEISI M.A.
Sex: Female
NPI: 1508050204
Last Updated: 2011-12-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1508050204 | ||||||||
| Enumeration Date | 2007-09-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3612 PINE ST IRVINE, CA 92606-2620 United States Phone: 949-350-5780 | Fax: | ||||||||
| Primary Practice Address | 3612 PINE ST IRVINE, CA 92606-2620 United States Phone: 949-350-5780 | Fax: | ||||||||
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