Provider Demographics
NPI:1376751321
Name:IBRAHIMI, SAID M (MD)
Entity Type:Individual
Prefix:
First Name:SAID
Middle Name:M
Last Name:IBRAHIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4847 HOPYARD RD
Mailing Address - Street 2:STE 4- 387
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 1:175 N JACKSON AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:669-235-4188
Practice Address - Fax:669-235-4221
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068365A2084N0400X
VA01012472582084N0400X
AZ433622084N0400X, 208VP0014X, 2084N0400X
CAA133812084N0400X
CAA1333812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144930OtherMEDICARE PTAN