Provider Demographics
NPI:1649496225
Name:MASHOUR, POURAN (PHD)
Entity type:Individual
Prefix:DR
First Name:POURAN
Middle Name:
Last Name:MASHOUR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E 16TH ST APT G306
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5953
Mailing Address - Country:US
Mailing Address - Phone:949-307-0429
Mailing Address - Fax:714-540-5906
Practice Address - Street 1:1810 E 16TH ST APT G306
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5953
Practice Address - Country:US
Practice Address - Phone:949-307-0429
Practice Address - Fax:714-540-5906
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21126103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist