Provider Demographics
NPI:1831466135
Name:SHAH, REHANA ANZAI (MSW)
Entity Type:Individual
Prefix:
First Name:REHANA
Middle Name:ANZAI
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13045 PACIFIC PROMENADE
Mailing Address - Street 2:UNIT 410
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2900
Mailing Address - Country:US
Mailing Address - Phone:310-625-5169
Mailing Address - Fax:
Practice Address - Street 1:13045 PACIFIC PROMENADE
Practice Address - Street 2:UNIT 410
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2900
Practice Address - Country:US
Practice Address - Phone:310-625-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 29086104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker