Healthcare Provider Details

I. General information

NPI: 1023362340
Provider Name (Legal Business Name): ABOONDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 W HERNDON AVE STE 80061
CLOVIS CA
93612-0191
US

IV. Provider business mailing address

605 W HERNDON AVE STE 80061
CLOVIS CA
93612-0191
US

V. Phone/Fax

Practice location:
  • Phone: 559-210-4333
  • Fax: 559-354-0952
Mailing address:
  • Phone: 559-210-4333
  • Fax: 559-354-0952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number46125775
License Number StateCA

VIII. Authorized Official

Name: MR. FRANK TURNER
Title or Position: PRESIDENT
Credential:
Phone: 559-210-4333