Healthcare Provider Details

I. General information

NPI: 1811287311
Provider Name (Legal Business Name): CAROLYN ABBASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST GME OFFICE CSP 21005
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST GME OFFICE CSP 21005
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 877-558-4015
  • Fax:
Mailing address:
  • Phone: 877-558-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA125641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: