Healthcare Provider Details

I. General information

NPI: 1811260573
Provider Name (Legal Business Name): NURAH ABDALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14456 SALINE DR
CORONA CA
92880-3770
US

IV. Provider business mailing address

1042 N MOUNTAIN AVE STE B #399
UPLAND CA
91786-3695
US

V. Phone/Fax

Practice location:
  • Phone: 714-388-2677
  • Fax: 714-683-0925
Mailing address:
  • Phone: 714-388-2677
  • Fax: 714-683-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number00023058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: