Provider Demographics
NPI:1548535123
Name:EBRAHIMIAN & EBRAHIMIAN INC
Entity type:Organization
Organization Name:EBRAHIMIAN & EBRAHIMIAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-438-4411
Mailing Address - Street 1:5 ERBA LN STE A
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4160
Mailing Address - Country:US
Mailing Address - Phone:831-438-4411
Mailing Address - Fax:831-438-1323
Practice Address - Street 1:5 ERBA LN STE A
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4160
Practice Address - Country:US
Practice Address - Phone:831-438-4411
Practice Address - Fax:831-438-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28543332BC3200X
CA28542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty