Healthcare Provider Details

I. General information

NPI: 1396847463
Provider Name (Legal Business Name): SIMA EBRAHIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S LAKE AVE SUITE #205
PASADENA CA
91106-3955
US

IV. Provider business mailing address

600 S LAKE AVE SUITE #205
PASADENA CA
91106-3955
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-6639
  • Fax: 626-408-6624
Mailing address:
  • Phone: 888-777-6639
  • Fax: 626-408-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: