Healthcare Provider Details

I. General information

NPI: 1659678563
Provider Name (Legal Business Name): CHRISTIAN THOMAS M ABELLA CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 02/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 GARCIA DR
VIRGINIA BEACH VA
23454-4850
US

IV. Provider business mailing address

453 GARCIA DR
VIRGINIA BEACH VA
23454-4850
US

V. Phone/Fax

Practice location:
  • Phone: 757-961-0142
  • Fax:
Mailing address:
  • Phone: 757-961-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: