Healthcare Provider Details

I. General information

NPI: 1780625376
Provider Name (Legal Business Name): DINA IBRAHIM M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINA IBRAHIM M.D.

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA ST STE 204
FRESNO CA
93710-5294
US

IV. Provider business mailing address

7065 N. MAPLE AVE STE 102
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-2100
  • Fax: 559-554-2114
Mailing address:
  • Phone: 559-554-2100
  • Fax: 559-554-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC51181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: