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General NPI Number Information
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NPI Number | 1518723394
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Entity Type | Individual
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Provider Name | MALLEK IBRAHIM ABDELBASET BIN MYRON
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Gender | Male
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST
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City | GARDENA
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State | CA
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Zip | 90248-4320
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Country | US
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Telephone | 424-354-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 9465 ROSEMARIE CT
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City | CYPRESS
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State | CA
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Zip | 90630-2858
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Country | US
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Telephone | 951-355-3338
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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