Provider Demographics
NPI:1699302240
Name:HAMED, EBRAHEEM H
Entity type:Individual
Prefix:
First Name:EBRAHEEM
Middle Name:H
Last Name:HAMED
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 1:1524 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5821
Mailing Address - Country:US
Mailing Address - Phone:786-564-3771
Mailing Address - Fax:909-474-9486
Practice Address - Street 1:13849 COBBLESTONE CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0504
Practice Address - Country:US
Practice Address - Phone:786-564-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361880884310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility