Provider Demographics
NPI:1356903728
Name:RAHMAN, SHAMIM
Entity type:Individual
Prefix:
First Name:SHAMIM
Middle Name:
Last Name:RAHMAN
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 1:25402 PACIFICA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3854
Mailing Address - Country:US
Mailing Address - Phone:949-238-2400
Mailing Address - Fax:
Practice Address - Street 1:3294 CRYSTAL RIDGE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-7944
Practice Address - Country:US
Practice Address - Phone:310-347-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health