Provider Demographics
NPI:1437443785
Name:MANAVI, SHADI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADI
Middle Name:
Last Name:MANAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SHADI
Other - Middle Name:
Other - Last Name:REFAEILZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:MISSION HOSPITAL LAGUNA BEACH EMERGENCY DEPARTMENT
Practice Address - City:LAGUNA
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-499-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122829207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine