Healthcare Provider Details

I. General information

NPI: 1063823599
Provider Name (Legal Business Name): PRINCESS MEDICAL GROUP APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 BROOKSHIRE AVE STE 301
DOWNEY CA
90241-4982
US

IV. Provider business mailing address

PO BOX 252125
LOS ANGELES CA
90025-8977
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-1112
  • Fax:
Mailing address:
  • Phone: 562-923-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG86496
License Number State

VIII. Authorized Official

Name: DR. ARIEL E ABRAHAMS I
Title or Position: PHYSICIAN PRESIDENT
Credential: M.D.
Phone: 562-923-1112