Provider Demographics
NPI:1225200041
Name:MOSLEHI, SHANAZ (PHD)
Entity Type:Individual
Prefix:
First Name:SHANAZ
Middle Name:
Last Name:MOSLEHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14360 SAINT ANDREWS DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4341
Mailing Address - Country:US
Mailing Address - Phone:760-245-4695
Mailing Address - Fax:760-245-5896
Practice Address - Street 1:14360 SAINT ANDREWS DR
Practice Address - Street 2:SUITE 11
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4341
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-245-5896
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16373104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker