Healthcare Provider Details

I. General information

NPI: 1225758360
Provider Name (Legal Business Name): SARAH KAMIL IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 GROSSMONT CENTER DR BLDG P
LA MESA CA
91942-3030
US

IV. Provider business mailing address

224 ROANOKE RD
EL CAJON CA
92020-4025
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-9592
  • Fax:
Mailing address:
  • Phone: 619-808-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: