Healthcare Provider Details

I. General information

NPI: 1497685648
Provider Name (Legal Business Name): JALAL IBRAHIM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

1540 CROOKED STICK DR
VALRICO FL
33596-7815
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-2000
  • Fax:
Mailing address:
  • Phone: 813-850-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: