Provider Demographics
NPI:1376239384
Name:SHAFA PSYCHIATRIC & CONSULTING CENTER APC
Entity Type:Organization
Organization Name:SHAFA PSYCHIATRIC & CONSULTING CENTER APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSRAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-341-4422
Mailing Address - Street 1:1400 N KRAEMER BLVD UNIT 171
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92871-1408
Mailing Address - Country:US
Mailing Address - Phone:165-734-1442
Mailing Address - Fax:
Practice Address - Street 1:16960 BASTANCHURY RD STE J
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1711
Practice Address - Country:US
Practice Address - Phone:714-693-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center