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General NPI Number Information
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NPI Number | 1891092797
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Entity Type | Organization
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Legal Business Name | CALIFORNIA INSTITUTE FOR CARDIOVASCULAR AND LASER VEIN SURG
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Dates
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Enumeration Date | 02/12/2011
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 16030 VENTURA BLVD STE 605
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City | ENCINO
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State | CA
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Zip | 91436-4471
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Country | US
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Telephone | 818-422-5322
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Fax | 818-578-8476
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Provider Business Mailing Address
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Address Line | 18375 VENTURA BLVD # 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 | 818-578-8476
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAM EBRAHIMI
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Credential | M.D.
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Telephone | 818-422-5322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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