Provider Demographics
NPI:1568221125
Name:IBRAHIM, MIRA
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MATLOCK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2947
Mailing Address - Country:US
Mailing Address - Phone:682-282-6648
Mailing Address - Fax:
Practice Address - Street 1:3201 MATLOCK RD STE 220
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2947
Practice Address - Country:US
Practice Address - Phone:682-282-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program