MEDICARE: DEANAH A JIBRIL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	20A17489	CA
2	207V00000X	Obstetrics & Gynecology Physician	J9718	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060DF	OTHER	TX	BLUE CROSS
2	2362989	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2544257	OTHER		CIGNA

General Provider Information

NPI Number	:	1134183114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANAH A JIBRIL DO

Provider Business Mailing Address
First Line	:	3212 SAINT GEORGES DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4719
Country	:	US
Telephone Number	:	972-867-4880
Fax Number	:	972-867-4881

Provider Business Practice Location Address
First Line	:	19330 JESSE LN STE 100
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5077
Country	:	US
Telephone Number	:	951-847-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	02/22/2020

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