MEDICARE: JUDITH ABESAMIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility
2	315P00000X	Intellectual Disabilities Intermediate Care Facility		CA

General Provider Information

NPI Number	:	1336592567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ABESAMIS

Provider Business Mailing Address
First Line	:	5241 CEDAR RIDGE WAY
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94531-8097
Country	:	US
Telephone Number	:	925-757-1379
Fax Number	:	925-978-2761

Provider Business Practice Location Address
First Line	:	2215 FIELD ST
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94509-3919
Country	:	US
Telephone Number	:	925-325-5344
Fax Number	:	925-978-2761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2016
Last Update Date	:	07/23/2016

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Directions to “ JUDITH ABESAMIS ” Practice Location

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