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General NPI Number Information
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NPI Number | 1144752833
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Entity Type | Organization
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Legal Business Name | TANNAZ EBRAHIMI ADIB, MD APC
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 01/01/2019
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Provider Practice Location Address
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Address Line | 3927 WARING RD STE D
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City | OCEANSIDE
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State | CA
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Zip | 92056-4458
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Country | US
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Telephone | 760-990-7585
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Fax | 951-750-5089
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Provider Business Mailing Address
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Address Line | 3927 WARING RD STE D
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City | OCEANSIDE
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State | CA
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Zip | 92056-4458
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Country | US
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Telephone | 760-990-7585
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Fax | 951-750-5089
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TANNAZ EBRAHIMI ADIB
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Credential | M.D.
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Telephone | 404-488-6364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A121761
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License Number State | CA
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