Organization
SHAFA PSYCHIATRIC AND CONSULTING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHOSRAVI GOHAR M.D (CEO PRESIDENT)
(657) 341-4422
Entity
Organization
Contact information
Practice address
265 S RANDOLPH AVE STE 290, BREA, CA 92821-5702
(657) 341-4422
Mailing address
1400 N KRAEMER BLVD UNIT 171, PLACENTIA, CA 92871-1408
(657) 341-4422
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912384611
NPI
—
Enumeration date
03/06/2023
Last updated
03/06/2023
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