Healthcare Provider Details

I. General information

NPI: 1922938505
Provider Name (Legal Business Name): CHRISTOPHER IBRAHIM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78880 SKYWARD WAY
LA QUINTA CA
92253-4934
US

IV. Provider business mailing address

78880 SKYWARD WAY
LA QUINTA CA
92253-4934
US

V. Phone/Fax

Practice location:
  • Phone: 760-895-0051
  • Fax:
Mailing address:
  • Phone: 760-895-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: