Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033489422 |
---|---|
Provider Name | Shabnam Shirazian Casey |
First Address | Culver City, CA 90230-4820 |
Second Address | Los Angeles, CA 90066-3840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 20/05/2013 |