Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C174844 | CA |
N | 208000000X | Pediatrician | P1988 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | C174844 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | ME129660 | FL |
NPI | 1295069375 |
---|---|
Provider Name | Mohammad Ebraheem |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018695700 | (05) | FL |