Healthcare Provider Details

I. General information

NPI: 1184327546
Provider Name (Legal Business Name): MARIAM EBRAHIMI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE
DALY CITY CA
94015-2228
US

IV. Provider business mailing address

2518 E OLIVERA RD
CONCORD CA
94519-2027
US

V. Phone/Fax

Practice location:
  • Phone: 650-395-0010
  • Fax:
Mailing address:
  • Phone: 925-435-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: