Healthcare Provider Details

I. General information

NPI: 1174951750
Provider Name (Legal Business Name): DIANA IBRAHIM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HOMELAND
IRVINE CA
92618-8801
US

IV. Provider business mailing address

30 HOMELAND
IRVINE CA
92618-8801
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-8944
  • Fax: 949-417-1637
Mailing address:
  • Phone: 949-387-8944
  • Fax: 949-417-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number59773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: