Individual
DR. EBRAHIM MAMOUR JAGNE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1329 E 1ST ST, SANTA ANA, CA 92701-6310
(714) 547-6542
Mailing address
1137 W 58TH PL, LOS ANGELES, CA 90044-3702
(310) 283-1279
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 12322
CA
Other
Enumeration date
01/21/2007
Last updated
07/08/2007
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