Healthcare Provider Details

I. General information

NPI: 1942310032
Provider Name (Legal Business Name): REBECCA ABU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SW 1ST ST BELLE GLADE
BELLE GLADE FL
33430-3472
US

IV. Provider business mailing address

12333 EQUINE LN WELLINGTON
WELLINGTON FL
33414-3503
US

V. Phone/Fax

Practice location:
  • Phone: 561-992-2316
  • Fax:
Mailing address:
  • Phone: 561-992-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 73613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: