Healthcare Provider Details

I. General information

NPI: 1093908378
Provider Name (Legal Business Name): DR IBRAHIM RABIDI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 E WASHINGTON BLVD
PASADENA CA
91104
US

IV. Provider business mailing address

2281 E WASHINGTON BLVD
PASADENA CA
91104
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-2606
  • Fax: 626-794-2879
Mailing address:
  • Phone: 626-794-2606
  • Fax: 626-794-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26278
License Number StateCA

VIII. Authorized Official

Name: DR. IBRAHIM A RABADI
Title or Position: OWNER
Credential: DDS
Phone: 626-794-2606