Healthcare Provider Details

I. General information

NPI: 1740274547
Provider Name (Legal Business Name): EDWARD EZRA ABDULLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 580
LOS ANGELES CA
90017-5854
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 580
LOS ANGELES CA
90017-5854
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-0419
  • Fax: 213-977-0225
Mailing address:
  • Phone: 213-977-0419
  • Fax: 213-977-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG59365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: