MEDICARE: MR. WASEEM N IBRAHIM M.D.

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	174400000X	Specialist	A44002	CA
2	2084N0400X	Neurology Physician	A44002	CA

General Provider Information

NPI Number	:	1346291374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WASEEM N IBRAHIM M.D.

Provider Business Mailing Address
First Line	:	7172 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-788-2224
Fax Number	:	951-788-5190

Provider Business Practice Location Address
First Line	:	7172 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-788-2224
Fax Number	:	951-788-5190

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/01/2022

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