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NPI Code Detail

MEDICARE: DR. IRENY I. IBRAHIM MD

MEDICARE: DR. IRENY I. IBRAHIM MD
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
1207R00000XInternal Medicine PhysicianA64541CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811944598
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRENY I. IBRAHIM MD
Provider Business Mailing Address
First Line : PO BOX 2200
Second Line :
City : REDLANDS
State : CA
Zip : 92373-0722
Country : US
Telephone Number : 909-793-3311
Fax Number : 909-796-4158
Provider Business Practice Location Address
First Line : 1300 E COOLEY DR
Second Line :
City : COLTON
State : CA
Zip : 92324-3905
Country : US
Telephone Number : 909-370-4179
Fax Number : 909-796-4158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/08/2007

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