Healthcare Provider Details

I. General information

NPI: 1063726586
Provider Name (Legal Business Name): THERESE SALAMA ABRAHAM P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 308
GLENDALE CA
91204-4644
US

IV. Provider business mailing address

519 E BROADWAY
GLENDALE CA
91205-1110
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-8800
  • Fax: 818-549-8811
Mailing address:
  • Phone: 818-409-3020
  • Fax: 818-243-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: