Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DDS104003 | CA |
N | 1223D0001X | Dental Public Health | DDS104003 | CA |
NPI | 1659927093 |
---|---|
Provider Name | Merna Ibrahim |
First Address | Downey, CA 90241-2161 |
Second Address | Downey, CA 90241-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |