Ebrahim Mamour Jagne Sr., PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA 12322 Issued in CA

Practice address

1329 E 1St St
Santa Ana, CA 92701-6310

Phone

(714) 547-6542

NPI assigned

Jan 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Dr Alonzo E Lockhart MD PC

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1548427032
  NPD (past)

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

{
    "created_epoch": "1169337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497808497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 W 58TH PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900443702",
            "telephone_number": "310-283-1279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 E 1ST ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927016310",
            "telephone_number": "714-547-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGNE",
        "first_name": "EBRAHIM",
        "middle_name": "MAMOUR",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 12322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ilyana Jacobson, LCSW
• Pamela Jean Jacobson, LAC
• Matthew Jacoby
• Jade Managed Health Care Corp
• Sarah Nichole Kasko Jafarpour, D.O.
• Marjon Bekhrad Jahromi, DDS
• Cesar Jaime
• Jalso Limited Liability Company
• James a. Kim, M.D. a Professional Medical Corporation
• James H. Wang D.D.S., Inc.

• Medical Physician Assistant in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.