Provider Demographics
NPI:1730128364
Name:IBRAHIM, RAGAA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGAA
Middle Name:R
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 KARENA CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3956
Mailing Address - Country:US
Mailing Address - Phone:805-987-2679
Mailing Address - Fax:805-987-2678
Practice Address - Street 1:3458 KARENA CT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3956
Practice Address - Country:US
Practice Address - Phone:805-987-2679
Practice Address - Fax:805-987-2679
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77068207R00000X, 207RA0000X
CAC52906207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49977YMedicare PIN
CABI163ZMedicare PIN