Healthcare Provider Details

I. General information

NPI: 1124810585
Provider Name (Legal Business Name): THEODORE MICHAEL ABNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD
CULVER CITY CA
90232-2732
US

IV. Provider business mailing address

9808 VENICE BLVD
CULVER CITY CA
90232-2732
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number140201
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: