Healthcare Provider Details

I. General information

NPI: 1265010995
Provider Name (Legal Business Name): MARINA KRISTY IBRAHEIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST # 280
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

1701 DIVISADERO ST # 280
SAN FRANCISCO CA
94115-3011
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA182460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: