Provider Demographics
NPI:1386799492
Name:SHAHAB, MANI FOAD (LAC)
Entity type:Individual
Prefix:
First Name:MANI
Middle Name:FOAD
Last Name:SHAHAB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 GUSS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4604
Mailing Address - Country:US
Mailing Address - Phone:714-350-8751
Mailing Address - Fax:
Practice Address - Street 1:27882 FORBES RD # 100
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1219
Practice Address - Country:US
Practice Address - Phone:949-364-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist