Provider Demographics
NPI:1063966299
Name:DALIA IBRAHIM-ABDELAZIZ MD
Entity type:Organization
Organization Name:DALIA IBRAHIM-ABDELAZIZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM-ABDELAZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-721-7217
Mailing Address - Street 1:14252 CULVER DR
Mailing Address - Street 2:#A338
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0317
Mailing Address - Country:US
Mailing Address - Phone:310-721-7217
Mailing Address - Fax:949-458-1291
Practice Address - Street 1:24411 HEALTH CENTER DR STE 430
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-452-3933
Practice Address - Fax:949-458-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131849207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty