Provider Demographics
NPI:1396047775
Name:ABRAHAM GOLBARI, M.D. A MEDICAL CORPORTATION
Entity type:Organization
Organization Name:ABRAHAM GOLBARI, M.D. A MEDICAL CORPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLBARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-327-8746
Mailing Address - Street 1:14030 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2715
Mailing Address - Country:US
Mailing Address - Phone:310-327-8746
Mailing Address - Fax:310-327-8748
Practice Address - Street 1:14030 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2715
Practice Address - Country:US
Practice Address - Phone:310-327-8746
Practice Address - Fax:310-327-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553870Medicaid
CA1639216468Medicaid