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General NPI Number Information
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NPI Number | 1568555225
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Entity Type | Organization
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Legal Business Name | SUE ABRAVESH M D INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE 310
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-218-1100
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Fax | 949-218-2323
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Provider Business Mailing Address
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Address Line | 26800 CROWN VALLEY PKWY SUITE 310
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6384
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Country | US
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Telephone | 949-218-1100
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Fax | 949-218-2323
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SOODABEH ABRAVESH
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Credential | M.D.
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Telephone | 949-218-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A70930
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License Number State | CA
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