Healthcare Provider Details

I. General information

NPI: 1831776806
Provider Name (Legal Business Name): MYRNA SALIM ABOUDIAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 05/27/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 VENTURA CANYON AVE
PANORAMA CITY CA
91402-6312
US

IV. Provider business mailing address

8001 VENTURA CANYON AVE
PANORAMA CITY CA
91402-6312
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA192987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: