Healthcare Provider Details

I. General information

NPI: 1134120124
Provider Name (Legal Business Name): ABBASI MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 LA JOLLA VILLAGE DR STE 201
LA JOLLA CA
92037-1480
US

IV. Provider business mailing address

PO BOX 231337
ENCINITAS CA
92023-1337
US

V. Phone/Fax

Practice location:
  • Phone: 858-433-4898
  • Fax: 858-433-4899
Mailing address:
  • Phone: 858-433-4898
  • Fax: 858-433-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA90215
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA44636
License Number StateCA

VIII. Authorized Official

Name: DR. ADIL A ABBASI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-775-7314