Provider Demographics
NPI:1457423436
Name:MOSHREFI, SHAIDA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAIDA
Middle Name:
Last Name:MOSHREFI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SHAIDA
Other - Middle Name:
Other - Last Name:MANSOUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5225 CANYON CREST DRIVE SUITE 17
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:951-222-2002
Mailing Address - Fax:952-686-8083
Practice Address - Street 1:5225 CANYON CREST DRIVE SUITE 17
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-222-2002
Practice Address - Fax:952-686-8083
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26974111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist