Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY26924 | CA |
N | 103TC0700X | Clinical Psychologist | PSY26924 | CA |
Y | 103TH0100X | Health Service | PSY26924 | CA |
NPI | 1376776492 |
---|---|
Provider Name | Dr. Shannon Chavez Qureshi |
First Address | Beverly Hills, CA 90211-3235 |
Second Address | Beverly Hills, CA 90211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 23/09/2019 |