Provider Demographics
NPI:1235886037
Name:IBRAHIM, FAWZY AHMED (DPM)
Entity type:Individual
Prefix:DR
First Name:FAWZY
Middle Name:AHMED
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3342 CERRITOS AVE APT 319
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2157
Mailing Address - Country:US
Mailing Address - Phone:201-207-2077
Mailing Address - Fax:
Practice Address - Street 1:3424 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4802
Practice Address - Country:US
Practice Address - Phone:619-295-9494
Practice Address - Fax:619-295-9714
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5915213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist