Provider Demographics
NPI:1861027633
Name:SHAHIDI, PARISA
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:SHAHIDI
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 1:25422 TRABUCO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2796
Mailing Address - Country:US
Mailing Address - Phone:949-350-7894
Mailing Address - Fax:
Practice Address - Street 1:14795 JEFFREY RD STE 204
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0417
Practice Address - Country:US
Practice Address - Phone:949-416-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor