Provider Demographics
NPI:1831513480
Name:FEHMI IBRAHIM, FATIMAH
Entity type:Individual
Prefix:
First Name:FATIMAH
Middle Name:
Last Name:FEHMI IBRAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 CALLE LOPEZ SICARDO
Mailing Address - Street 2:URB. SAN AGUSTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-453-2616
Mailing Address - Fax:
Practice Address - Street 1:1152 CALLE LOPEZ SICARDO
Practice Address - Street 2:URB SAN AGUSTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3223
Practice Address - Country:US
Practice Address - Phone:787-453-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist