Provider Demographics
NPI:1164663860
Name:EBRAHIMI ADIB, TANNAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:
Last Name:EBRAHIMI ADIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANNAZ
Other - Middle Name:EBRAHIMI
Other - Last Name:ADIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3927 WARING RD STE D
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4458
Mailing Address - Country:US
Mailing Address - Phone:760-990-7585
Mailing Address - Fax:951-750-5089
Practice Address - Street 1:3927 WARING RD STE D
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4458
Practice Address - Country:US
Practice Address - Phone:760-990-7585
Practice Address - Fax:951-750-5089
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108488174400000X
CAA121761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist