Healthcare Provider Details

I. General information

NPI: 1922528975
Provider Name (Legal Business Name): ADITI ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 CAMINO ARROYO
GILROY CA
95020-7348
US

IV. Provider business mailing address

7475 CAMINO ARROYO
GILROY CA
95020-7348
US

V. Phone/Fax

Practice location:
  • Phone: 669-263-2847
  • Fax: 408-852-2236
Mailing address:
  • Phone: 407-649-6876
  • Fax: 408-852-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA167232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: