Provider Demographics
NPI:1205238227
Name:SHAHROOZI, SHAHROKH (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAHROKH
Middle Name:
Last Name:SHAHROOZI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:SHAHROOZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1339 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2033
Mailing Address - Country:US
Mailing Address - Phone:310-829-8065
Mailing Address - Fax:310-829-8455
Practice Address - Street 1:1339 20TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2033
Practice Address - Country:US
Practice Address - Phone:310-829-8065
Practice Address - Fax:310-829-8455
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist