Healthcare Provider Details

I. General information

NPI: 1013161306
Provider Name (Legal Business Name): SUNIL J ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13010 HESPERIA ROAD STE. 300
VICTORVILLE CA
92395-8315
US

IV. Provider business mailing address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-7873
  • Fax: 760-843-7831
Mailing address:
  • Phone: 760-242-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA109069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: