Healthcare Provider Details

I. General information

NPI: 1962224824
Provider Name (Legal Business Name): ABIDALI PROFESSIONAL MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCHENRY AVE STE L
MODESTO CA
95350-3253
US

IV. Provider business mailing address

1285 KENDRA LN
UPLAND CA
91784-9269
US

V. Phone/Fax

Practice location:
  • Phone: 480-251-4030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOUSTAPHA ABIDALI
Title or Position: OWNER
Credential: DO
Phone: 480-251-4030