Healthcare Provider Details

I. General information

NPI: 1457820763
Provider Name (Legal Business Name): NNENNA ABAEZE ABAEZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 04/22/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 ARGONNE AVE STE 3
LONG BEACH CA
90803-3231
US

IV. Provider business mailing address

206 N JACKSON ST
GLENDALE CA
91206-4330
US

V. Phone/Fax

Practice location:
  • Phone: 562-434-6007
  • Fax: 562-856-2370
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: