MEDICARE: IBRAHIMI MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A128575	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A128575	OTHER	CA	CA - LICENSE

General Provider Information

NPI Number	:	1902325707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBRAHIMI MEDICAL INC

Provider Business Mailing Address
First Line	:	4847 HOPYARD RD STE 4-411
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-3360
Country	:	US
Telephone Number	:	669-235-4188
Fax Number	:	669-235-4221

Provider Business Practice Location Address
First Line	:	1081 MARKET PL STE 500
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4750
Country	:	US
Telephone Number	:	925-365-7337
Fax Number	:	925-522-4372

Authorized Official
Title or Position	:	OWNER
Name	:	MR. IBRAHIMI WAHEED
Credential	:	MD
Telephone Number	:	510-512-0533

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	04/17/2023

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Directions to “IBRAHIMI MEDICAL INC ” Practice Location

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