Basic Information
| Provider Information | |||||||||
| NPI: | 1851954523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKKARI | ||||||||
| FirstName: | IBRAHIM | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25213 LEMONGRASS ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928833115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6572546061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3700 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907121419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625312550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | EL6902 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.