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General NPI Number Information
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NPI Number | 1306852934
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Entity Type | Individual
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Provider Name | MAGED FAYEZ IBRAHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 16465 SIERRA LAKES PKWY
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-823-8000
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Fax | 909-823-8088
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Provider Business Mailing Address
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Address Line | 6180 CANTABRIA AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-6990
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Country | US
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Telephone | 693-579-6092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301076933
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01071369A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C141296
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License Number State | CA
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