Healthcare Provider Details

I. General information

NPI: 1306954755
Provider Name (Legal Business Name): CHRISTINA A. KABBASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119
US

IV. Provider business mailing address

PO BOX 11392
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4221
  • Fax: 239-348-4193
Mailing address:
  • Phone: 866-949-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number229102
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME132938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: