Healthcare Provider Details

I. General information

NPI: 1902325707
Provider Name (Legal Business Name): IBRAHIMI MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
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 STE 4-411
PLEASANTON CA
94588-3360
US

V. Phone/Fax

Practice location:
  • Phone: 925-365-7337
  • Fax: 925-522-4372
Mailing address:
  • Phone: 669-235-4188
  • Fax: 669-235-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128575
License Number StateCA

VIII. Authorized Official

Name: MR. IBRAHIMI WAHEED
Title or Position: OWNER
Credential: MD
Phone: 510-512-0533