Provider Demographics
NPI:1396847463
Name:EBRAHIMI, SIMA
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S LAKE AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3955
Mailing Address - Country:US
Mailing Address - Phone:888-777-6639
Mailing Address - Fax:626-408-6624
Practice Address - Street 1:600 S LAKE AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3955
Practice Address - Country:US
Practice Address - Phone:888-777-6639
Practice Address - Fax:626-408-6624
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
CAAC15514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No171100000XOther Service ProvidersAcupuncturist