Healthcare Provider Details

I. General information

NPI: 1992292007
Provider Name (Legal Business Name): DR. NAHRIN VERONICA EBRAHIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N VIRGIL AVE
LOS ANGELES CA
90004-4811
US

IV. Provider business mailing address

19 TACOMA ST
WORCESTER MA
01605-3516
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: