MEDICARE: IBRAHIM ZAKI ALSMADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	E0159312018-1	NV

General Provider Information

NPI Number	:	1366373938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBRAHIM ZAKI ALSMADI

Provider Business Mailing Address
First Line	:	7358 EMERALD GLOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1303
Country	:	US
Telephone Number	:	702-353-1143
Fax Number	:	702-444-4877

Provider Business Practice Location Address
First Line	:	7358 EMERALD GLOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1303
Country	:	US
Telephone Number	:	702-353-1143
Fax Number	:	702-444-4877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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