Healthcare Provider Details

I. General information

NPI: 1790946895
Provider Name (Legal Business Name): AHMAD ABOU ABBASS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 351
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY STE 351
MISSION VIEJO CA
92691-6374
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1007
  • Fax: 949-364-6057
Mailing address:
  • Phone: 949-364-1007
  • Fax: 949-364-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number4301091303
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301091303
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA152200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: