NPIMap

Individual provider Active NPI

Mina Boshra Ghattas Ibrahim

  • Pharmacist
  • Los Angeles, CA
National Provider Identifier
1104205244
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
72485 Issued in CA
Practice address
4633 Santa Monica Blvd
Los Angeles, CA 90029-1803
Phone
(323) 666-6125
NPI assigned
May 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 72485 CA Primary

Addresses

Primary practice location

4633 Santa Monica Blvd
Los Angeles, CA 90029-1803

Mailing address

10623 Pangborn Ave
Downey, CA 90241-2939
Phone (562) 522-4686

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary RX Inc Current Accepting new patients
Thrifty Payless Inc Past Accepting new patients
Thrifty Payless Inc Past Accepting new patients

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1104205244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10623 PANGBORN AVE",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902412939",
            "telephone_number": "562-522-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 SANTA MONICA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291803",
            "telephone_number": "323-666-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MINA",
        "middle_name": "BOSHRA GHATTAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "72485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.