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General NPI Number Information
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NPI Number | 1114371481
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Entity Type | Organization
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Legal Business Name | EMAD IBRAHIM, MD, INC.
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 245 TERRACINA BLVD STE 206
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City | REDLANDS
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State | CA
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Zip | 92373-4867
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Country | US
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Telephone | 909-793-4336
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Fax | 909-793-3325
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Provider Business Mailing Address
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Address Line | 527 ACACIA CT
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City | REDLANDS
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State | CA
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Zip | 92373-5667
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Country | US
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Telephone | 909-557-3983
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Fax | 909-335-6162
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Authorized Official
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Title or Position | OWNER
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Name | EMAD IBRAHIM
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Credential | M.D.
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Telephone | 909-557-3983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | A51062
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License Number State | CA
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