Provider Demographics
NPI:1255148904
Name:IBRAHEEM, TOBI TAOFIK (DPT)
Entity type:Individual
Prefix:MR
First Name:TOBI
Middle Name:TAOFIK
Last Name:IBRAHEEM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1294 W 6TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2997
Mailing Address - Country:US
Mailing Address - Phone:310-547-1850
Mailing Address - Fax:310-547-1972
Practice Address - Street 1:1294 W 6TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2997
Practice Address - Country:US
Practice Address - Phone:310-547-1850
Practice Address - Fax:310-547-1972
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT307364208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation