Healthcare Provider Details

I. General information

NPI: 1447200761
Provider Name (Legal Business Name): PETER ABACI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15047 LOS GATOS BLVD STE 200
LOS GATOS CA
95032-2054
US

IV. Provider business mailing address

15047 LOS GATOS BLVD STE 200
LOS GATOS CA
95032-2054
US

V. Phone/Fax

Practice location:
  • Phone: 408-364-6799
  • Fax: 408-378-4510
Mailing address:
  • Phone: 408-364-6799
  • Fax: 408-378-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG76565
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG76565
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberG76565
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG76565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: