Provider Demographics
NPI:1336940014
Name:AL SHAMMAA, IBRAHEEM
Entity type:Individual
Prefix:
First Name:IBRAHEEM
Middle Name:
Last Name:AL SHAMMAA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 TREE SWALLOW CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8110
Mailing Address - Country:US
Mailing Address - Phone:916-892-9724
Mailing Address - Fax:
Practice Address - Street 1:3109 TREE SWALLOW CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8110
Practice Address - Country:US
Practice Address - Phone:916-892-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE195911146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic