Provider Demographics
NPI:1144366063
Name:IBRAHIM, SAMEER
Entity type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N. VERMONT AVE. SUITE 1
Mailing Address - Street 2:1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029
Mailing Address - Country:US
Mailing Address - Phone:323-662-6916
Mailing Address - Fax:323-662-5736
Practice Address - Street 1:1233 N VERMONT AVE
Practice Address - Street 2:1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1749
Practice Address - Country:US
Practice Address - Phone:323-662-6916
Practice Address - Fax:323-662-5736
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23530111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic