Healthcare Provider Details

I. General information

NPI: 1487301099
Provider Name (Legal Business Name): ABBY ALEXANDRA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E LELAND RD STE 100
PITTSBURG CA
94565-4961
US

IV. Provider business mailing address

1340 ARNOLD DR STE 127
MARTINEZ CA
94553-4189
US

V. Phone/Fax

Practice location:
  • Phone: 925-439-9628
  • Fax:
Mailing address:
  • Phone: 925-370-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: