MEDICARE: ROBERTO ABDELNUR, M.D. INC.

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	207RC0000X	Cardiovascular Disease Physician	A36085	CA

General Provider Information

NPI Number	:	1699910711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO ABDELNUR, M.D. INC.

Provider Business Mailing Address
First Line	:	1503 N IMPERIAL AVE STE 201
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6302
Country	:	US
Telephone Number	:	760-353-5933
Fax Number	:	760-352-9961

Provider Business Practice Location Address
First Line	:	1503 N IMPERIAL AVE STE 201
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-6302
Country	:	US
Telephone Number	:	760-353-5933
Fax Number	:	760-352-9961

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SANDRA REAL
Credential	:
Telephone Number	:	760-353-5933

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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