Basic Information
| Provider Information | |||||||||
| NPI: | 1386171973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JIBREL | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | MOHAMED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 DUDLEY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029052401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012741122 | ||||||||
| FaxNumber: | 7342326020 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 DUDLEY ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029052401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012741122 | ||||||||
| FaxNumber: | 4014590100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301111864 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD17541 | RI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.