Provider Demographics
NPI:1134183114
Name:JIBRIL, DEANAH A (DO)
Entity type:Individual
Prefix:
First Name:DEANAH
Middle Name:A
Last Name:JIBRIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 SAINT GEORGES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4719
Mailing Address - Country:US
Mailing Address - Phone:972-867-4880
Mailing Address - Fax:972-867-4881
Practice Address - Street 1:19330 JESSE LN STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5077
Practice Address - Country:US
Practice Address - Phone:951-847-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17489207V00000X
TXJ9718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060DFOtherBLUE CROSS
TX2362989OtherAETNA
TX030902301Medicaid
2544257OtherCIGNA
2544257OtherCIGNA
TX00687DMedicare ID - Type Unspecified