Healthcare Provider Details

I. General information

NPI: 1154441061
Provider Name (Legal Business Name): NAEEM ABUASSAF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 FOREST SHADE, SUITE 4
CRESTLINE CA
92325-0989
US

IV. Provider business mailing address

164 FREMONT DR P.O.BOX 3182
LAKE ARROWHEAD CA
92352-3182
US

V. Phone/Fax

Practice location:
  • Phone: 909-338-6477
  • Fax:
Mailing address:
  • Phone: 626-260-2959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: