Provider Demographics
NPI:1760016166
Name:ALJUMAIE, IZZAT SALEH
Entity Type:Individual
Prefix:
First Name:IZZAT
Middle Name:SALEH
Last Name:ALJUMAIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 GARFIELD AVE APT 146
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2851
Mailing Address - Country:US
Mailing Address - Phone:916-519-5992
Mailing Address - Fax:
Practice Address - Street 1:7509 MADISON AVE STE 114
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7464
Practice Address - Country:US
Practice Address - Phone:916-314-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist