OrganizationActive
Pediatric Adolescent Clinic
NPI 1164859385 · Pediatric Adolescent Medicine Physician · Upland, CA
Provider details
- NPI number
- 1164859385
- Entity type
- Organization
- Primary specialty
- Pediatric Adolescent Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Raouf Ibrahim, Pediatrician(909) 946-4175
- License
- AFE33327 (CA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1214 Adriana Way
Upland, CA 91784-1742
Phone: (909) 946-4155
Fax: (909) 949-8836
Street-level locationGet directions
Mailing address
1214 Adriana Way
Upland, CA 91784
Registry dates
- Enumerated
- 2013-10-02
- Last updated
- 2013-10-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.