Provider Demographics
NPI:1083461990
Name:SHADIA, MARWA
Entity type:Individual
Prefix:
First Name:MARWA
Middle Name:
Last Name:SHADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 W CATALPA AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4054
Mailing Address - Country:US
Mailing Address - Phone:951-956-3932
Mailing Address - Fax:
Practice Address - Street 1:23121 VERDUGO DR STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1339
Practice Address - Country:US
Practice Address - Phone:949-520-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist