Active NPI
Mahmoud Ali Ibrahim, MD
- Pediatrics Physician
- Rancho Cucamonga, CA
National Provider Identifier
1063451771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A42803
- Practice address
- 7974 Haven Ave
Ste. 290
Rancho Cucamonga, CA 91730-3052 - Phone
- (909) 944-5553
- Fax
- (909) 944-3339
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A42803 | CA | Primary |
| Pediatric Endocrinology Physician | 2080P0205X | A42803 | CA |
Addresses
Primary practice location
7974 Haven Ave
Ste. 290
Rancho Cucamonga, CA 91730-3052
Mailing address
7974 Haven Ave
Ste. 290
Rancho Cucamonga, CA 91730-3052
Phone (909) 944-5553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A42803 | CA | MD | Pediatric Endocrinology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Antonio Regional Hospital | Past | Accepting new patients | |
| Chino Medical Group, Inc | Pediatrics | Past | Accepting new patients |
| Primecare Medical Group | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Upland, CA
- NPI 1780681189
-
- Internal Medicine Physician
- Tampa, FL
- NPI 1093720427
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353974400000",
"number": "1063451771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 HAVEN AVE",
"address_2": "STE. 290",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303052",
"telephone_number": "909-944-5553",
"fax_number": "909-944-3339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7974 HAVEN AVE",
"address_2": "STE. 290",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303052",
"telephone_number": "909-944-5553",
"fax_number": "909-944-3339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "MAHMOUD",
"middle_name": "ALI",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2012-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A42803",
"primary": true
},
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "CA",
"license": "A42803",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.