1679033781 NPI number — DR. NEDA EBRAHIMI MD

Table of content: DR. NEDA EBRAHIMI MD (NPI 1679033781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679033781 NPI number — DR. NEDA EBRAHIMI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBRAHIMI
Provider First Name:
NEDA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679033781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38383 N CAMPBELL AVE BLDG 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-874-2251
Provider Business Mailing Address Fax Number:
520-621-2919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1656 E MABEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85721-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-626-6376
Provider Business Practice Location Address Fax Number:
520-621-2919
Provider Enumeration Date:
03/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  R79425 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)