Healthcare Provider Details

I. General information

NPI: 1255530077
Provider Name (Legal Business Name): DOUGLAS J ABELES, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21030 REDWOOD ROAD
CASTRO VALLEY CA
94546-5920
US

IV. Provider business mailing address

21030 REDWOOD RD
CASTRO VALLEY CA
94546-5920
US

V. Phone/Fax

Practice location:
  • Phone: 510-538-0430
  • Fax: 510-538-1839
Mailing address:
  • Phone: 510-538-0430
  • Fax: 510-538-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG079953
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS ABELES
Title or Position: OWNER
Credential:
Phone: 510-538-0430