Healthcare Provider Details

I. General information

NPI: 1811930928
Provider Name (Legal Business Name): AZIZ IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15717 PARAMOUNT BLVD.
PARAMOUNT CA
90723-4332
US

IV. Provider business mailing address

15717 PARAMOUNT BLVD.
PARAMOUNT CA
90723-4332
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-2231
  • Fax: 562-231-8845
Mailing address:
  • Phone: 562-531-2231
  • Fax: 562-231-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-6980
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC165562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: