Provider Demographics
NPI:1730525536
Name:ANSARI, SHIRIN (PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:ANSARI
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 1:16220 SCIENTIFIC
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4349
Mailing Address - Country:US
Mailing Address - Phone:949-654-2424
Mailing Address - Fax:949-654-2428
Practice Address - Street 1:16220 SCIENTIFIC
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4349
Practice Address - Country:US
Practice Address - Phone:949-654-2424
Practice Address - Fax:949-654-2428
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical