Provider Demographics
NPI:1114933314
Name:EBRAHIMI, ABDOLRASOOL (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDOLRASOOL
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 CHARTRES DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275
Mailing Address - Country:US
Mailing Address - Phone:310-677-9131
Mailing Address - Fax:310-677-0254
Practice Address - Street 1:575 E HARDY STREET
Practice Address - Street 2:SUITE 221
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-677-9131
Practice Address - Fax:310-544-7262
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC405200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C405200OtherBLUE SHIELD
CA00C405200Medicaid