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IBRAHIM FATTAH MD
NPI 1679278204
Student in an Organized Health Care Education/Training Program in Sacramento, CA

Active since April 03, 2023PECOS Enrolled
2315 STOCKTON BLVD, SACRAMENTO, CA 95817(916) 734-2011 Get Directions Write a Review

NPPES record last updated: October 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 6, 2025, Apr 3, 2023 (2 updates tracked since 2023).

About Ibrahim Fattah Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IBRAHIM FATTAH MD (NPI 1679278204) is an individual student in an organized health care education/training program in Sacramento, California and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1679278204
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameIBRAHIM FATTAHCredential: MD
Location Address2315 STOCKTON BLVDSacramento, CA 95817-2201
Mailing Address2315 Stockton BlvdSacramento, CA 95817-2201
Phone(916) 734-2011
Sole ProprietorYes
Medical School CMSOtherGraduated 2023
Enumeration DateApril 3, 2023
Last NPPES UpdateOctober 6, 20252 updates tracked since enumeration
NPPES CertifiedOctober 6, 2025
✔ NPI 1679278204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Also ListedEmergency MedicineTaxonomy 207P00000X · License A203065 (CA)
2315 STOCKTON BLVD, Sacramento, CA 95817
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ibrahim Fattah Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7315422185
PECOS Enrollment IDI20260330002454
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHLEEN STUCKER
Social Worker (Clinical)
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-5628
MARIA ISABEL AGUILAR
Registered Nurse
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-8730
NATHAN JACOB VANDEN BERGE
Emergency Medicine
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-8570
PETER SANTIAGO C.O., C.PED., FAAOP
Specialist
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-7045
SHIELA LEIGH SAMSON ANGULO DO
Student in an Organized Health Care Education/Training Program
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-5974
MS. KATHLEEN DOLORES VAN LEEUWEN MD
Surgery (Pediatric Surgery)
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-3229
STEPHEN MULFORD
Physical Therapy Assistant
2315 STOCKTON BLVD, ROOM 0512
SACRAMENTO, CA 95817
Sacramento County (916) 734-7248
MR. MARK YAMADA
Occupational Therapist
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Sacramento County (916) 734-7248

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ibrahim Fattah's NPI number?

The NPI number for Ibrahim Fattah is 1679278204. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Where is Ibrahim Fattah located?

Ibrahim Fattah practices at 2315 Stockton Blvd, Sacramento, CA 95817. The listed phone number is (916) 734-2011.

What is Ibrahim Fattah's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ibrahim Fattah enrolled in Medicare?

Yes. Ibrahim Fattah is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ibrahim Fattah was last updated on October 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.