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General NPI Number Information
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NPI Number | 1780498584
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Entity Type | Organization
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Legal Business Name | ABS UTAH, P.C.
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 2711 RANDOLPH RD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28207-2027
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Country | US
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Telephone | 626-658-8947
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Fax |
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Provider Business Mailing Address
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Address Line | 16255 VENTURA BLVD STE 900
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City | ENCINO
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State | CA
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Zip | 91436-2317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTING
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Name | ALICE PALEY
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Credential |
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Telephone | 626-658-8947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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