Healthcare Provider Details

I. General information

NPI: 1649284670
Provider Name (Legal Business Name): GEORGE IBRAHIM GIRGIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14004 FREMANTLE CT
BAKERSFIELD CA
93314-9298
US

IV. Provider business mailing address

14004 FREMANTLE CT
BAKERSFIELD CA
93314-9298
US

V. Phone/Fax

Practice location:
  • Phone: 661-589-6661
  • Fax: 661-637-1112
Mailing address:
  • Phone: 661-589-6661
  • Fax: 661-637-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA43715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: