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General NPI Number Information
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NPI Number | 1114916376
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Entity Type | Individual
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Provider Name | SAM A EBRAHIMI MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 10/23/2016
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Provider Practice Location Address
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Address Line | 18375 VENTURA BLVD SUITE# 404
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City | TARZANA
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State | CA
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Zip | 91356-4218
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Country | US
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Telephone | 818-422-5322
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Fax |
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Provider Business Mailing Address
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Address Line | 18375 VENTURA BLVD SUITE# 404
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City | TARZANA
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State | CA
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Zip | 91356-4218
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Country | US
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Telephone | 301-537-7751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD33806
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101233742
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | D0059318
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | A060777
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License Number State | CA
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