Healthcare Provider Details

I. General information

NPI: 1467818294
Provider Name (Legal Business Name): SHABNAM RAHIMI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E OCEAN BLVD #12
LONG BEACH CA
90802-1985
US

IV. Provider business mailing address

1310 E OCEAN BLVD # 12
LONG BEACH CA
90802-6900
US

V. Phone/Fax

Practice location:
  • Phone: 801-856-1108
  • Fax:
Mailing address:
  • Phone: 801-856-1108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9366271
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95005018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: