Provider Demographics
NPI:1902325707
Name:IBRAHIMI MEDICAL INC
Entity Type:Organization
Organization Name:IBRAHIMI MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-512-0533
Mailing Address - Street 1:4847 HOPYARD RD STE 4-411
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3360
Mailing Address - Country:US
Mailing Address - Phone:669-235-4188
Mailing Address - Fax:669-235-4221
Practice Address - Street 1:1081 MARKET PL STE 500
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4750
Practice Address - Country:US
Practice Address - Phone:925-365-7337
Practice Address - Fax:925-522-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA128575OtherCA - LICENSE
CAA128575OtherCA - LICENSE