Healthcare Provider Details

I. General information

NPI: 1255424404
Provider Name (Legal Business Name): FAHMY IBRAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FAHMY IBRAHIM M.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

IV. Provider business mailing address

500 N 9TH ST STE A
MODESTO CA
95350-5814
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-5300
  • Fax: 209-209-5255
Mailing address:
  • Phone: 209-525-5300
  • Fax: 209-209-5255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA89455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: