Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 61374 | CA |
NPI | 1063760965 |
---|---|
Provider Name | Dr. Ninus Ebrahimi |
First Address | Valencia, CA 91355 |
Second Address | Valencia, CA 91355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 16/03/2016 |