Provider Demographics
NPI:1619040292
Name:ABDULRAHIM, AHMED MAYET (DC)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:MAYET
Last Name:ABDULRAHIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:MAYET
Other - Last Name:ABDULRAHIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1620 ALPINE BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1104
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:
Practice Address - Street 1:1620 ALPINE BLVD STE 119
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1104
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611492736111N00000X
CADC28335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1699216754Medicaid