Healthcare Provider Details

I. General information

NPI: 1174716583
Provider Name (Legal Business Name): WAHEED SAID IBRAHIMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARKET PL STE 500
SAN RAMON CA
94583-4750
US

IV. Provider business mailing address

4847 HOPYARD RD SUITE 4411
PLEASANTON CA
94588-3360
US

V. Phone/Fax

Practice location:
  • Phone: 925-365-7337
  • Fax: 925-522-4372
Mailing address:
  • Phone: 510-512-0533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42035
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: