Healthcare Provider Details

I. General information

NPI: 1730449885
Provider Name (Legal Business Name): ANGELA IBRAGIMOV M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

15866 N 17TH WAY
PHOENIX AZ
85022-3376
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-2923
  • Fax:
Mailing address:
  • Phone: 602-373-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50567
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: