Healthcare Provider Details

I. General information

NPI: 1427587377
Provider Name (Legal Business Name): TALAB IBRAHIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 12/03/2021
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST
FRESNO CA
93701-2302
US

IV. Provider business mailing address

1805 MEDICAL CENTER DR
SAN BERNARDINO CA
92411-1217
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6500
  • Fax:
Mailing address:
  • Phone: 909-223-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA162341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: