Provider Demographics
NPI:1003862137
Name:DELSHADI, LANA (EDD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:
Last Name:DELSHADI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 CHERRY ST STE 211
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:714-229-0094
Mailing Address - Fax:714-229-0180
Practice Address - Street 1:10861 CHERRY ST STE 211
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:714-229-0094
Practice Address - Fax:714-229-0180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16895103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP16895CMedicare ID - Type Unspecified
CAP24716Medicare UPIN
CAWCP16895DMedicare ID - Type Unspecified