Provider Demographics
NPI:1447886130
Name:SAATSAZ, SHAHED
Entity type:Individual
Prefix:MR
First Name:SHAHED
Middle Name:
Last Name:SAATSAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29405 RANCHO CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6201
Mailing Address - Country:US
Mailing Address - Phone:951-417-7997
Mailing Address - Fax:
Practice Address - Street 1:29405 RANCHO CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6201
Practice Address - Country:US
Practice Address - Phone:951-417-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1985793103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANCF381W04478OtherHEALTH INSURANCE