Provider Demographics
NPI:1154695765
Name:GITI, SHARI MOWLAVI (PSYD)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:MOWLAVI
Last Name:GITI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:MOWLAVI
Other - Last Name:GITI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1601 PACIFIC COAST HWY STE 290
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3283
Mailing Address - Country:US
Mailing Address - Phone:424-888-4484
Mailing Address - Fax:
Practice Address - Street 1:1601 PACIFIC COAST HWY STE 290
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3283
Practice Address - Country:US
Practice Address - Phone:424-888-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical