Healthcare Provider Details

I. General information

NPI: 1669291316
Provider Name (Legal Business Name): ABUNDANT HEALTH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 128
TEMECULA CA
92591-4680
US

IV. Provider business mailing address

27450 YNEZ RD STE 128
TEMECULA CA
92591-4680
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-4333
  • Fax:
Mailing address:
  • Phone: 951-383-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE CHRISTINE MYERS
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 951-383-4333