Provider Demographics
NPI:1659708295
Name:FAHIMI, RAHA IDA (OD)
Entity Type:Individual
Prefix:DR
First Name:RAHA
Middle Name:IDA
Last Name:FAHIMI
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:27271 LAS RAMBLAS STE 210
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8042
Mailing Address - Country:US
Mailing Address - Phone:949-652-7236
Mailing Address - Fax:714-878-0866
Practice Address - Street 1:955 S CARILLO AVE
Practice Address - Street 2:STE 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-954-5800
Practice Address - Fax:855-897-2998
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA2386152W00000X
NJ27OA00650700152W00000X
CA34405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist