MEDICARE: ABACUS BUSINESS CORPORATION GROUP 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	291U00000X	Clinical Medical Laboratory	104749-60	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821091067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABACUS BUSINESS CORPORATION GROUP INC.

Provider Business Mailing Address
First Line	:	2730 N MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-3321
Country	:	US
Telephone Number	:	323-222-6688
Fax Number	:	323-222-3388

Provider Business Practice Location Address
First Line	:	2730 N MAIN ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-3321
Country	:	US
Telephone Number	:	323-222-6688
Fax Number	:	323-222-3388

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID SOMALI
Credential	:
Telephone Number	:	323-222-6688

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/29/2022

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