Organization Name: | AZITA S. EBRAHIMI DDS INC |
NPI Number: | 1114257235 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AZITA SHEILA EBRAHIMI (OWNER, PRESIDENT) |
Mailing Address: | 25662 Crown Valley Pkwy Ste H4 Ladera Ranch |
State: | CA US |
Postal Code: | 926940486 |
Phone Number: | 9492762990 |
Fax Number: | |
NPI Enumeration Date: | 01/12/2010 |
NPI Last Update Date: | 01/12/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 52505 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |