Healthcare Provider Details

I. General information

NPI: 1720516743
Provider Name (Legal Business Name): MATTHEW ABRISHAMIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W STEWART DR
ORANGE CA
92868-3891
US

IV. Provider business mailing address

1100 W STEWART DR
ORANGE CA
92868-3891
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8000
  • Fax:
Mailing address:
  • Phone: 714-771-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT213671
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA164295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: