Healthcare Provider Details

I. General information

NPI: 1083088652
Provider Name (Legal Business Name): VORTEX PSYCHIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 BLACKHAWK PLAZA CIR STE 240
DANVILLE CA
94506-4613
US

IV. Provider business mailing address

3860 BLACKHAWK RD STE 170
DANVILLE CA
94506-4668
US

V. Phone/Fax

Practice location:
  • Phone: 925-648-2650
  • Fax: 925-648-2530
Mailing address:
  • Phone: 925-648-2650
  • Fax: 925-648-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA129171
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberA129171
License Number StateCA

VIII. Authorized Official

Name: DR. SAID ALI IBRAHIMI
Title or Position: OWNER
Credential: MD
Phone: 925-648-2650