=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295880698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODNEY EBRAHIMIAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 S BARRINGTON AVE STE 305
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-5379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-666-8009
-----------------------------------------------------
Fax | 424-325-6236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 S BARRINGTON AVE STE 305
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-5379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-405-1610
-----------------------------------------------------
Fax | 310-337-0947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | A78264
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------