Provider Demographics
NPI:1437489341
Name:EBRAHIMI, MASEEH
Entity Type:Individual
Prefix:
First Name:MASEEH
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 OLIVER PL
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-1380
Mailing Address - Country:US
Mailing Address - Phone:925-548-6987
Mailing Address - Fax:
Practice Address - Street 1:8851 OLIVER PL
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-1380
Practice Address - Country:US
Practice Address - Phone:925-548-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT34892246RP1900X
CA155795246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy