Healthcare Provider Details

I. General information

NPI: 1003329624
Provider Name (Legal Business Name): ABIGAIL PASCUAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALABRIA LN
FOOTHILL RANCH CA
92610-1902
US

IV. Provider business mailing address

1 DREXEL DR
NEW ORLEANS LA
70125-1056
US

V. Phone/Fax

Practice location:
  • Phone: 949-633-6468
  • Fax:
Mailing address:
  • Phone: 504-736-4800
  • Fax: 504-736-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: