Provider Demographics
NPI:1013948934
Name:TOBBAGI, HABIB (MD)
Entity Type:Individual
Prefix:DR
First Name:HABIB
Middle Name:
Last Name:TOBBAGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-259-2013
Mailing Address - Fax:408-259-2327
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-259-2013
Practice Address - Fax:408-259-2327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25977Medicare UPIN
CA00A301260Medicare ID - Type UnspecifiedMEDICARE PROVIDER#