MEDICARE: DONIA IBRAHIM PA-C

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	363A00000X	Physician Assistant	50.006526RX	OH
2	363A00000X	Physician Assistant	8710	AZ

General Provider Information

NPI Number	:	1275159840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONIA IBRAHIM PA-C

Provider Business Mailing Address
First Line	:	4700 S MCCLINTOCK DR STE 140
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	480-590-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 S MCCLINTOCK DR STE 140
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	480-590-0787
Fax Number	:

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

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	07/03/2024

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Directions to “ DONIA IBRAHIM PA-C” Practice Location

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