Healthcare Provider Details

I. General information

NPI: 1356502116
Provider Name (Legal Business Name): DALIA AL-MUDALLAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DALIA IBRAHIM M.D.

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR STE 430
LAGUNA HILLS CA
92653-3633
US

IV. Provider business mailing address

14252 CULVER DR # A338
IRVINE CA
92604-0317
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-3933
  • Fax: 949-458-1291
Mailing address:
  • Phone: 310-721-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73892
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101248509
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA131849
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101248509
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number76377
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number73892
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: