Provider Demographics
NPI:1467818294
Name:RAHIMI, SHABNAM (ARNP)
Entity Type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E OCEAN BLVD # 12
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-6900
Mailing Address - Country:US
Mailing Address - Phone:801-856-1108
Mailing Address - Fax:
Practice Address - Street 1:1310 E OCEAN BLVD #12
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1985
Practice Address - Country:US
Practice Address - Phone:801-856-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9366271363LF0000X
CANP95005018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily