Provider Demographics
NPI:1356843494
Name:DEHMOBAD NASRABADI, SHAHRZAD JAMSHID
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:JAMSHID
Last Name:DEHMOBAD NASRABADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PLANTATION
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3433
Mailing Address - Country:US
Mailing Address - Phone:949-500-2984
Mailing Address - Fax:
Practice Address - Street 1:881 DOVER DR STE 380
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6932
Practice Address - Country:US
Practice Address - Phone:949-500-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20573396101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor