Individual
SAM A EBRAHIMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18375 VENTURA BLVD, SUITE# 404, TARZANA, CA 91356-4218
(818) 422-5322
Mailing address
18375 VENTURA BLVD, SUITE# 404, TARZANA, CA 91356-4218
(301) 537-7751
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
0101233742
VA
2086S0129X
Vascular Surgery Physician
D0059318
MD
2086S0129X
Vascular Surgery Physician
MD33806
DC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A060777
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035556900
—
DC
01
—
100336
JHHC PRIORITY PARTNER
—
05
—
404465702
—
MD
01
—
4129526
MAMSI LIFE & HEALTH
—
01
—
484AWA
CAREFIRST MARYLAND
MD
01
—
J449-0010
CAREFIRST
DC
01
—
P00435744
RAILROAD MEDICARE
DC
Enumeration date
10/19/2005
Last updated
10/23/2016
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