Basic Information
| Provider Information | |||||||||
| NPI: | 1861692485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDOSS | ||||||||
| FirstName: | IBRAHIM | ||||||||
| MiddleName: | TAHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 512185 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900510185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267753514 | ||||||||
| FaxNumber: | 6264083911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. DUARTE RD. | ||||||||
| Address2: | DEPARTMENT OF HEMATOLOGY & HCT | ||||||||
| City: | DUARTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262564673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2007 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5582 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | A111706 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 208M00000X | A111706 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RH0000X | A11706 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 1902846306 | 01 | CA | GROUP NPI | OTHER | 1861692485 | 05 | IA | MEDICAID | W18762 | 01 | CA | GROUP MEDICARE | OTHER | GR0100430 | 01 | CA | GROUP MEDI-CAL | OTHER |