Organization
PEDIATRIC ADOLESCENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAOUF AZIZ IBRAHIM I M.D. (PEDIATRICIAN)
(909) 946-4175
Entity
Organization
Contact information
Practice address
1214 ADRIANA WAY, UPLAND, CA 91784-1742
(909) 946-4155
(909) 949-8836
Mailing address
1214 ADRIANA WAY, UPLAND, CA 91784
(909) 946-4155
(909) 949-8836
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
AFE33327
CA
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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