Healthcare Provider Details

I. General information

NPI: 1659424943
Provider Name (Legal Business Name): ABRAHAM TZADIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 15TH ST STE 405
SANTA MONICA CA
90404-1813
US

IV. Provider business mailing address

1304 15TH ST STE 405
SANTA MONICA CA
90404-1813
US

V. Phone/Fax

Practice location:
  • Phone: 310-305-1020
  • Fax: 310-823-4785
Mailing address:
  • Phone: 310-305-1020
  • Fax: 310-823-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA43023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: