Provider Demographics
NPI:1942451323
Name:SAFARI-JAEFARLOO, SHOELEH
Entity Type:Individual
Prefix:MS
First Name:SHOELEH
Middle Name:
Last Name:SAFARI-JAEFARLOO
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 1:22622 LAMBERT ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1609
Mailing Address - Country:US
Mailing Address - Phone:949-768-4327
Mailing Address - Fax:949-768-4009
Practice Address - Street 1:22622 LAMBERT ST
Practice Address - Street 2:301#B
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1609
Practice Address - Country:US
Practice Address - Phone:949-768-4327
Practice Address - Fax:949-768-4009
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor