Provider Demographics
NPI:1588355770
Name:AL KOHLA, IBRAHIM MOHAMMED A
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:MOHAMMED A
Last Name:AL KOHLA
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 1:6514 W TURQUOISE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1033
Mailing Address - Country:US
Mailing Address - Phone:480-395-3679
Mailing Address - Fax:
Practice Address - Street 1:6514 W TURQUOISE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1033
Practice Address - Country:US
Practice Address - Phone:480-395-3679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)