Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 0101233742 | VA |
N | 2086S0129X | Vascular Surgeon | D0059318 | MD |
N | 2086S0129X | Vascular Surgeon | MD33806 | DC |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A060777 | CA |
NPI | 1114916376 |
---|---|
Provider Name | Sam A Ebrahimi |
First Address | Tarzana, CA 91356-4218 |
Second Address | Tarzana, CA 91356-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 23/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035556900 | (05) | DC |
100336 | JHHC PRIORITY PARTNER (01) | |
404465702 | (05) | MD |
4129526 | MAMSI LIFE & HEALTH (01) | |
484AWA | CAREFIRST MARYLAND (01) | MD |
H78581 | (02) | |
J449-0010 | CAREFIRST (01) | DC |
P00435744 | RAILROAD MEDICARE (01) | DC |