Healthcare Provider Details

I. General information

NPI: 1700276177
Provider Name (Legal Business Name): BRIDGE MEDICAL CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE STE 202
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

4847 HOPYARD RD SUITE 4 BOX 387
PLEASANTON CA
94588-3360
US

V. Phone/Fax

Practice location:
  • Phone: 669-235-4188
  • Fax: 669-235-4221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA133381
License Number StateCA

VIII. Authorized Official

Name: SAID M IBRAHIMI
Title or Position: PRESIDENT
Credential: MD
Phone: 669-235-4188