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1700428711 NPI number — ISLAM GAMAL IBRAHIM PA-C

NPI Number: 1700428711
Health Care Provider/Practitioner: ISLAM GAMAL IBRAHIM PA-C

Information about “1700428711” NPI (ISLAM GAMAL IBRAHIM PA-C) exists in 1700428711 in HTML format HTML  |  1700428711 in plain Text format TXT  |  1700428711 in PDF (Portable Document Format) PDF  |  1700428711 in an XML format XML  formats.

NPI Number : 1700428711 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700428711",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IBRAHIM",
    "FirstName": "ISLAM",
    "MiddleName": "GAMAL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1415 LEDGESTONE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "POMONA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91767-3566",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-528-1507",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1415 LEDGESTONE LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "POMONA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91767-3566",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "305-528-1507",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/10/2019",
    "LastUpdateDate": "09/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207QA0505X",
          "TaxonomyName": "Adult Medicine Physician",
          "LicenseNumber": "57291",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA57291",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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