Provider Demographics
NPI:1841053840
Name:SHIRAZI, JASMINE (MA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SHIRAZI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 PARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4803
Mailing Address - Country:US
Mailing Address - Phone:310-666-8266
Mailing Address - Fax:
Practice Address - Street 1:2309 PACIFIC COAST HWY STE 207
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2753
Practice Address - Country:US
Practice Address - Phone:424-272-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT142623106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist