Healthcare Provider Details

I. General information

NPI: 1164734513
Provider Name (Legal Business Name): DENISSE ABDO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 30TH ST
SAN DIEGO CA
92104-4120
US

IV. Provider business mailing address

3544 30TH ST
SAN DIEGO CA
92104-4120
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2424
  • Fax: 619-683-7570
Mailing address:
  • Phone: 619-515-2424
  • Fax: 619-683-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number978853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: