Healthcare Provider Details

I. General information

NPI: 1083934129
Provider Name (Legal Business Name): MARIANNE EBRAHIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE M102
BEVERLY HILLS CA
90211-2288
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD STE M102
BEVERLY HILLS CA
90211-2288
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3380
  • Fax:
Mailing address:
  • Phone: 310-385-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA130314
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10037192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: