Provider Demographics
NPI:1053838987
Name:KATIBAH, IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:
Last Name:KATIBAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IBRAHIM
Other - Middle Name:
Other - Last Name:KATIBAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:568 E HERNDON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-558-8671
Mailing Address - Fax:559-573-7121
Practice Address - Street 1:568 E HERNDON AVE STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2989
Practice Address - Country:US
Practice Address - Phone:559-558-8671
Practice Address - Fax:559-573-7121
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170300207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology