Provider Demographics
NPI:1467630277
Name:SHARIFI, PROSHAD SHADI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PROSHAD
Middle Name:SHADI
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24520 HAWTHORNE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6843
Mailing Address - Country:US
Mailing Address - Phone:310-738-1603
Mailing Address - Fax:
Practice Address - Street 1:24520 HAWTHORNE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6843
Practice Address - Country:US
Practice Address - Phone:310-738-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical