Provider Demographics
NPI:1720366677
Name:HABIB A. ISMAIL, M.D., INC.
Entity Type:Organization
Organization Name:HABIB A. ISMAIL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-2831
Mailing Address - Street 1:1330 W COVINA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3200
Mailing Address - Country:US
Mailing Address - Phone:626-914-2831
Mailing Address - Fax:909-599-6217
Practice Address - Street 1:1330 W COVINA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:626-914-2831
Practice Address - Fax:909-599-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA435232084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty