1104103084 NPI number — MRS. SHIRLI HAMUDOT LIBET MFT

Table of content: MRS. SHIRLI HAMUDOT LIBET MFT (NPI 1104103084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104103084 NPI number — MRS. SHIRLI HAMUDOT LIBET MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIBET
Provider First Name:
SHIRLI
Provider Middle Name:
HAMUDOT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMUDOT
Provider Other First Name:
SHIRLI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104103084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28059 CARAWAY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA CLARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91350-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-267-9284
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 WESTWIND DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93301-3055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-327-4252
Provider Business Practice Location Address Fax Number:
661-327-3409
Provider Enumeration Date:
11/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC47822 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)