Provider Demographics
NPI:1942521653
Name:GIBANI, SIRAJ MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:SIRAJ
Middle Name:MOHAMED
Last Name:GIBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIRAJEDDIN
Other - Middle Name:MOHAMED
Other - Last Name:GIBANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:255 E BONITA AVE BLDG 9
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1923
Mailing Address - Country:US
Mailing Address - Phone:909-450-0369
Mailing Address - Fax:909-450-0366
Practice Address - Street 1:255 E BONITA AVE BLDG 9
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-450-0369
Practice Address - Fax:909-450-0366
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT197841207T00000X
CA(909)331-2731207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery