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General NPI Number Information
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NPI Number | 1003434275
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Entity Type | Individual
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Provider Name | ANTONIOUS JONAH ABRAHAM PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 246 W COLLEGE ST FL 3
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City | COVINA
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State | CA
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Zip | 91723-1910
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Country | US
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Telephone | 626-915-1911
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Fax | 626-915-2668
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Provider Business Mailing Address
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Address Line | 293 N STATE COLLEGE BLVD APT 3068
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City | ORANGE
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State | CA
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Zip | 92868-5724
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Country | US
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Telephone | 978-325-1322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 58382
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License Number State | CA
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