Provider Demographics
NPI:1649960659
Name:IBRAHIM, ELENI ADEM I
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:ADEM
Last Name:IBRAHIM
Suffix:I
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:ELENI
Other - Middle Name:ADEM
Other - Last Name:IBRAHIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31864 FRONTIER MANOR ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7461
Mailing Address - Country:US
Mailing Address - Phone:951-357-7397
Mailing Address - Fax:
Practice Address - Street 1:31864 FRONTIER MANOR ST
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584
Practice Address - Country:US
Practice Address - Phone:951-357-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8MIK544343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)