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General NPI Number Information
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NPI Number | 1114100401
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Entity Type | Organization
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Legal Business Name | IMELDA F. ABAKAN
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 126 SUNFISH CT
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City | VALLEJO
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State | CA
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Zip | 94591-7121
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Country | US
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Telephone | 707-980-6399
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Fax |
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Provider Business Mailing Address
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Address Line | 126 SUNFISH CT
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City | VALLEJO
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State | CA
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Zip | 94591-7121
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Country | US
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Telephone | 707-980-6399
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Fax |
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Authorized Official
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Title or Position | L.V.N.
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Name | MS. IMELDA FLORIA ABAKAN
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Credential |
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Telephone | 707-980-6399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | VN101924
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License Number State | CA
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