Provider Demographics
NPI:1922419308
Name:ABUMARIA, IBRAHIM MAHMOUD (AGPCNP)
Entity Type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:MAHMOUD
Last Name:ABUMARIA
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MOONDALE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4237
Mailing Address - Country:US
Mailing Address - Phone:915-227-7457
Mailing Address - Fax:888-334-4417
Practice Address - Street 1:625 MOONDALE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4237
Practice Address - Country:US
Practice Address - Phone:915-227-7457
Practice Address - Fax:888-334-4417
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124995363LG0600X, 363L00000X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care