Provider Demographics
NPI:1689247819
Name:BAHADORI RAD, SHADI
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:BAHADORI RAD
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 1:1115 SULLIVAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4249
Mailing Address - Country:US
Mailing Address - Phone:310-351-9504
Mailing Address - Fax:
Practice Address - Street 1:1115 SULLIVAN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4249
Practice Address - Country:US
Practice Address - Phone:310-351-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor