Provider Demographics
NPI:1598397739
Name:IBRAHIM, NASIR ADAM
Entity Type:Individual
Prefix:
First Name:NASIR
Middle Name:ADAM
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 1:4009 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-1452
Mailing Address - Country:US
Mailing Address - Phone:520-369-1752
Mailing Address - Fax:
Practice Address - Street 1:4009 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1452
Practice Address - Country:US
Practice Address - Phone:520-369-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide