Healthcare Provider Details

I. General information

NPI: 1912161787
Provider Name (Legal Business Name): LOUI ABDELGHANI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

IV. Provider business mailing address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 92-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME128546
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC170753
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME128546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: