Healthcare Provider Details

I. General information

NPI: 1336083377
Provider Name (Legal Business Name): TESNEEM IBRAHIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

310 GLEN HOLLOW ST
CEDAR PARK TX
78613-4158
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10097549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: