Healthcare Provider Details

I. General information

NPI: 1245281856
Provider Name (Legal Business Name): JEAN-JACQUES ABITBOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7625 MESA COLLEGE DR STE 310A
SAN DIEGO CA
92111-5343
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 TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME117249
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG55587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: