=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699910711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERTO ABDELNUR, M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2008
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1503 N IMPERIAL AVE STE 201
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-353-5933
-----------------------------------------------------
Fax | 760-352-9961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1503 N IMPERIAL AVE STE 201
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-353-5933
-----------------------------------------------------
Fax | 760-352-9961
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SANDRA REAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-353-5933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A36085
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------