Provider Demographics
NPI:1013406032
Name:MOHAMED ISMAIL, SHEIK ABDULLAH (CNA)
Entity Type:Individual
Prefix:MR
First Name:SHEIK ABDULLAH
Middle Name:
Last Name:MOHAMED ISMAIL
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S BERENDO ST APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2133
Mailing Address - Country:US
Mailing Address - Phone:714-916-3155
Mailing Address - Fax:
Practice Address - Street 1:447 S BERENDO ST APT 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2133
Practice Address - Country:US
Practice Address - Phone:714-916-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies