Healthcare Provider Details

I. General information

NPI: 1336226976
Provider Name (Legal Business Name): ABIGAIL ALABA CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

630 S LINCOLN AVE UNIT 1
EL CAJON CA
92020-5372
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-8224
  • Fax:
Mailing address:
  • Phone: 619-692-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00663092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: