Healthcare Provider Details

I. General information

NPI: 1881143063
Provider Name (Legal Business Name): NATALIA M EBRAHIMIAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date: 12/02/2021
Reactivation Date: 12/30/2021

III. Provider practice location address

11037 WARNER AVE # 339
FOUNTAIN VALLEY CA
92708-4007
US

IV. Provider business mailing address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-4292
  • Fax: 949-253-4627
Mailing address:
  • Phone: 858-216-8837
  • Fax: 949-253-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number22911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: