=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275147068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUSSEIN ABIDALI, D.O. DIGESTIVE HEALTH INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2020
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7974 HAVEN AVE STE 210
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-301-0550
-----------------------------------------------------
Fax | 909-301-0626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7974 HAVEN AVE STE 210
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-3052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-941-0661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GASTROENTEROLOGIST
-----------------------------------------------------
Name | HUSSEIN ABIDALI
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 480-251-5887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------