Provider Demographics
NPI:1063728780
Name:GHAED, SHIVA GENEVIEVE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:GENEVIEVE
Last Name:GHAED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29829 SANTA MARGARITA PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3622
Mailing Address - Country:US
Mailing Address - Phone:619-852-1766
Mailing Address - Fax:
Practice Address - Street 1:29829 SANTA MARGARITA PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3622
Practice Address - Country:US
Practice Address - Phone:619-852-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical