Provider Demographics
NPI:1437287257
Name:SHAHBANI-YEGANEH, MITRA -
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:-
Last Name:SHAHBANI-YEGANEH
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 1:2121 E 1ST ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2403
Mailing Address - Country:US
Mailing Address - Phone:562-434-1126
Mailing Address - Fax:562-434-1126
Practice Address - Street 1:2183 FAIRVIEW RD STE 100
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5671
Practice Address - Country:US
Practice Address - Phone:949-515-5440
Practice Address - Fax:949-515-5444
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist