Healthcare Provider Details

I. General information

NPI: 1053312868
Provider Name (Legal Business Name): LARA ACCAD ABBOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAN FERNANDO RD
SAN FERNANDO CA
91340-3115
US

IV. Provider business mailing address

1172 N MACLAY AVE
SAN FERNANDO CA
91340-1328
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8086
  • Fax: 818-898-4826
Mailing address:
  • Phone: 818-898-1388
  • Fax: 818-365-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: