Provider Demographics
NPI:1013747021
Name:YAGHOUBI, SHILA RIVKA
Entity type:Individual
Prefix:
First Name:SHILA
Middle Name:RIVKA
Last Name:YAGHOUBI
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 1:8537 CLIFTON WAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2236
Mailing Address - Country:US
Mailing Address - Phone:310-855-2713
Mailing Address - Fax:
Practice Address - Street 1:5657 WILSHIRE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3755
Practice Address - Country:US
Practice Address - Phone:323-525-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist