Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC23530 | CA |
NPI | 1144366063 |
---|---|
Provider Name | Sameer Ibrahim |
First Address | Los Angeles, CA 90029 |
Second Address | Los Angeles, CA 90029-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |