Healthcare Provider Details

I. General information

NPI: 1013853449
Provider Name (Legal Business Name): AVICENNA CLINICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 TERRACINA BLVD STE 104B
REDLANDS CA
92373-4870
US

IV. Provider business mailing address

13105 SILVERLEAF CT
REDLANDS CA
92373-7471
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ISLAM ABUDAYYEH
Title or Position: OWNER
Credential: MD
Phone: 949-300-8660