Healthcare Provider Details

I. General information

NPI: 1245168830
Provider Name (Legal Business Name): IBRAHIM AHMAD ABOURA-ARIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 W 1245 N
LAYTON UT
84041-7736
US

IV. Provider business mailing address

2605 W 1245 N
LAYTON UT
84041-7736
US

V. Phone/Fax

Practice location:
  • Phone: 385-477-8499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: