Individual
BASSANT ABDELKEREM IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
149 PASADENA AVE STE A, SOUTH PASADENA, CA 91030-3351
(323) 274-3065
Mailing address
940 AVENUE 64, PASADENA, CA 91105-2711
(323) 543-2800
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/12/2021
Last updated
09/11/2023
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