Healthcare Provider Details

I. General information

NPI: 1609420132
Provider Name (Legal Business Name): ADRIANA I. ABDALAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PARK AVE
LONG BEACH CA
90803-3146
US

IV. Provider business mailing address

47 PARK AVE
LONG BEACH CA
90803-3146
US

V. Phone/Fax

Practice location:
  • Phone: 562-260-2378
  • Fax:
Mailing address:
  • Phone: 562-260-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number90649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: