Basic Information
| Provider Information | |||||||||
| NPI: | 1366989980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EBRAHIMI | ||||||||
| FirstName: | ARINEH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10605 BALBOA BLVD | ||||||||
| Address2: | SUIT # 100 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188326174 | ||||||||
| FaxNumber: | 8188322567 | ||||||||
| Practice Location | |||||||||
| Address1: | 10605 BALBOA BLVD | ||||||||
| Address2: | SUIT # 100 | ||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188326174 | ||||||||
| FaxNumber: | 8188322567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2017 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | CA | Y | Other Service Providers | Community Health Worker |
No ID Information.