=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730387150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ABRAHAMSON MD. FACC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 09/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1415 TERRACE WAY
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-715-4934
-----------------------------------------------------
Fax | 949-715-4934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1415 TERRACE WAY
-----------------------------------------------------
City | LAGUNA BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92651-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-715-4934
-----------------------------------------------------
Fax | 949-715-4934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A43554
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------