# CALIFORNIA INSTITUTE FOR CARDIOVASCULAR AND LASER VEIN SURG

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891092797
- **Authorized official:** DR. SAM EBRAHIMI M.D. (OWNER)
- **Authorized official phone:** (818) 422-5322

## Contact information

- **Practice address:** 16030 VENTURA BLVD STE 605, ENCINO, CA 91436-4471
- **Practice address phone:** (818) 422-5322
- **Practice address fax:** (818) 578-8476
- **Mailing address:** 18375 VENTURA BLVD \# 404, TARZANA, CA 91356-4218
- **Mailing address phone:** (818) 422-5322
- **Mailing address fax:** (818) 578-8476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | A060777 | CA | Yes |

## Other

- **Enumeration date:** 02/12/2011
- **Last updated:** 04/29/2016