Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 045147 | NJ |
NPI | 1205589306 |
---|---|
Provider Name | Ghazaleh Ebrahimi |
First Address | Lake Mary, FL 32746-5354 |
Second Address | Heathrow, FL 32746-7201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045147 | OTHER (01) | NJ |