Healthcare Provider Details

I. General information

NPI: 1487803409
Provider Name (Legal Business Name): JEAN-JACQUES ABITBOL M D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 RUFFIN RD STE 102
SAN DIEGO CA
92123-1338
US

IV. Provider business mailing address

5395 RUFFIN RD STE 102
SAN DIEGO CA
92123-1338
US

V. Phone/Fax

Practice location:
  • Phone: 858-874-2306
  • Fax: 858-874-2356
Mailing address:
  • Phone: 858-874-2306
  • Fax: 858-874-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG55587
License Number StateCA

VIII. Authorized Official

Name: DR. JEAN-JACQUES ABITBOL
Title or Position: CEO
Credential: M.D.
Phone: 858-874-2306