Individual
MR. ABDOLRASOOL EBRAHIMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
575 E HARDY STREET, SUITE 221, INGLEWOOD, CA 90301
(310) 677-9131
(310) 544-7262
Mailing address
6390 CHARTRES DR, RANCHO PALOS VERDES, CA 90275
(310) 677-9131
(310) 677-0254
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C405200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C405200
BLUE SHIELD
CA
05
—
00C405200
—
CA
Enumeration date
07/31/2006
Last updated
07/08/2007
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