Healthcare Provider Details

I. General information

NPI: 1942829494
Provider Name (Legal Business Name): VIVEK MATHEW ABRAHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR. ORTHOPAEDIC SURGERY
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

200 MERCY CIR. ORTHOPAEDIC SURGERY
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1619
  • Fax:
Mailing address:
  • Phone: 760-725-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA210009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: