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NPI 1215200357

NPI 1215200357 : LEYLA RAHIMI DDS : EUREKA, CA

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General NPI Number Information
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    NPI Number           |    1215200357
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    Entity Type          |    Individual 
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    Provider Name        |    LEYLA RAHIMI DDS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/21/2012
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    Last Update Date     |    03/17/2014
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Provider Practice Location Address
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    Address Line         |    959 MYRTLE AVENUE 
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    City                 |    EUREKA
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    State                |    CA
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    Zip                  |    95501
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    Country              |    US
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    Telephone            |    707-442-7078
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    Fax                  |    707-442-7298
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Provider Business Mailing Address
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    Address Line         |    670 9TH STREET SUITE 203
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    City                 |    ARCATA
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    State                |    CA
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    Zip                  |    95521
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    Country              |    US
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    Telephone            |    707-826-8633
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    Fax                  |    707-826-8638
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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        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    61172
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    License Number State |    CA
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