Rana Ibrahim

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS105874 Issued in CA

Practice address

607 W Channel Islands Blvd
Port Hueneme, CA 93041-2136

Phone

(805) 985-5500

NPI assigned

Jan 10, 2021

Last updated

Jan 10, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Apollo General Dentistry LLC

  • Dental Clinic/Center
  • North Royalton, OH
  • NPI 1467279307
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610236800000",
    "number": "1710575246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W CHANNEL ISLANDS BLVD",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412136",
            "telephone_number": "805-985-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W CHANNEL ISLANDS BLVD",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412136",
            "telephone_number": "805-985-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "RANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-10",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS105874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Roger Heglin, IDC
• Michael Kenneth Holler, D.M.D
• Lamar Alan Hooper
• Taj-Zsa Marie Hower
• Hueneme Elementary School District
• Geoffrey Samuel Jacoby, MD
• Suleiman Jangikhan, PHARMD
• Gyutae Jin, DMD
• Fernando Juarez, OTHER
• Piotor Juchniewicz, IDC

• General Practice Dentistry in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.