Healthcare Provider Details

I. General information

NPI: 1093631814
Provider Name (Legal Business Name): MR. SAIFENNASR ISMAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 VICTOR AVE APT 2
INGLEWOOD CA
90302-2646
US

IV. Provider business mailing address

901 VICTOR AVE APT 2
INGLEWOOD CA
90302-2646
US

V. Phone/Fax

Practice location:
  • Phone: 310-739-9931
  • Fax:
Mailing address:
  • Phone: 310-739-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number161451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: