Provider Demographics
NPI:1679033781
Name:EBRAHIMI, NEDA (MD)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:EBRAHIMI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 N LA CHOLLA BLVD #240
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-0001
Mailing Address - Country:US
Mailing Address - Phone:520-326-1457
Mailing Address - Fax:833-944-2162
Practice Address - Street 1:6130 N LA CHOLLA BLVD #240
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-0001
Practice Address - Country:US
Practice Address - Phone:520-326-1457
Practice Address - Fax:833-944-2162
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR79425207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program