Healthcare Provider Details

I. General information

NPI: 1043252489
Provider Name (Legal Business Name): ABIGAIL BUHAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

IV. Provider business mailing address

4405 VANDEVER AVE
SAN DIEGO CA
92120-3315
US

V. Phone/Fax

Practice location:
  • Phone: 800-290-5000
  • Fax:
Mailing address:
  • Phone: 800-290-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA91792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: