Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY30671 | CA |
Y | 103T00000X | Psychologist | PSY30671 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1265781140 |
---|---|
Provider Name | Dr. Sheila Modir |
First Address | Orange, CA 92868-4244 |
Second Address | Orange, CA 92868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 30/01/2019 |