Healthcare Provider Details

I. General information

NPI: 1487002218
Provider Name (Legal Business Name): FATIMEH ABDALLAH P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 409
NEWPORT BEACH CA
92660-7705
US

IV. Provider business mailing address

13636 DIX TOLEDO RD
SOUTHGATE MI
48195-2432
US

V. Phone/Fax

Practice location:
  • Phone: 949-640-4501
  • Fax: 949-640-0741
Mailing address:
  • Phone: 734-283-2262
  • Fax: 734-283-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007782
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: