Provider Demographics
NPI:1780564252
Name:RAHIMI, SANAM
Entity type:Individual
Prefix:
First Name:SANAM
Middle Name:
Last Name:RAHIMI
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 1:1416 LACHMAN LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2232
Mailing Address - Country:US
Mailing Address - Phone:914-269-2172
Mailing Address - Fax:
Practice Address - Street 1:311 NORTH ST STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2232
Practice Address - Country:US
Practice Address - Phone:914-269-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1943788251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist