Individual
MADONNA IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
7910 FROST ST STE 320, SAN DIEGO, CA 92123
(619) 488-6196
Mailing address
7910 FROST ST STE 320, SAN DIEGO, CA 92123-2791
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO04103
—
224P00000X
Prosthetist
Primary
CPO04103
—
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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