Individual
IBRAHIM BOURAKBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1713 WOODDALE BLVD STE 30, BATON ROUGE, LA 70806-1570
(225) 421-1114
(833) 790-2013
Mailing address
1713 WOODDALE BLVD STE 30, BATON ROUGE, LA 70806-1570
(225) 421-1114
(833) 790-2013
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A827745
LA
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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