Provider Demographics
NPI:1740028760
Name:HASHEMI, SHAWDON
Entity type:Individual
Prefix:
First Name:SHAWDON
Middle Name:
Last Name:HASHEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 OPAL RDG
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8801
Mailing Address - Country:US
Mailing Address - Phone:818-397-3904
Mailing Address - Fax:
Practice Address - Street 1:2112 OPAL RDG
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8801
Practice Address - Country:US
Practice Address - Phone:818-397-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6624224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant