Organization
CALIFORNIA INSTITUTE FOR CARDIOVASCULAR AND LASER VEIN SURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM EBRAHIMI M.D. (OWNER)
(818) 422-5322
Entity
Organization
Contact information
Practice address
16030 VENTURA BLVD STE 605, ENCINO, CA 91436-4471
(818) 422-5322
(818) 578-8476
Mailing address
18375 VENTURA BLVD # 404, TARZANA, CA 91356-4218
(818) 422-5322
(818) 578-8476
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
A060777
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035556900
—
DC
05
—
404465702
—
MD
Enumeration date
02/12/2011
Last updated
04/29/2016
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