Healthcare Provider Details

I. General information

NPI: 1295858215
Provider Name (Legal Business Name): DAVID ROBLES ABIVA II PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12522 LAMBERT RD
WHITTIER CA
90606-2758
US

IV. Provider business mailing address

16418 MYRA LN
CERRITOS CA
90703-1524
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5420
  • Fax: 562-967-2929
Mailing address:
  • Phone: 714-318-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17760
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA17760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: