Provider Demographics
NPI:1447414099
Name:ALMOHAMMAD ALJOMAH, GHANIM (MD)
Entity Type:Individual
Prefix:
First Name:GHANIM
Middle Name:
Last Name:ALMOHAMMAD ALJOMAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GHANIM
Other - Middle Name:
Other - Last Name:ALJOMAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7117 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2658
Mailing Address - Country:US
Mailing Address - Phone:951-782-3684
Mailing Address - Fax:951-378-4325
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2658
Practice Address - Country:US
Practice Address - Phone:951-782-3684
Practice Address - Fax:951-784-3256
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2067552080P0206X
AZ635352080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07776356Medicaid
LA1174777Medicaid
MS07776356Medicaid