Healthcare Provider Details

I. General information

NPI: 1083865042
Provider Name (Legal Business Name): EILEEN CARIDAD ABEJAR PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

455 S MAIN ST PULMONARY/RSV CLINIC
ORANGE CA
92868-3835
US

IV. Provider business mailing address

455 SOUTH MAIN STREET, PULMONARY / RSV CLINIC CHILDREN'S HOSPITAL OF ORANGE COUNTY
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-8709
  • Fax: 714-289-4072
Mailing address:
  • Phone: 714-532-8709
  • Fax: 714-289-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number362991
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number17310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: