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General NPI Number Information
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NPI Number | 1790775278
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Entity Type | Individual
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Provider Name | MAZEN ISSAM ABBAS D.O., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL # SE09
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 559-353-5745
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Fax | 559-353-6093
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Provider Business Mailing Address
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Address Line | 1015 AOLOA PL APT 259
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City | KAILUA
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State | HI
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Zip | 96734-5212
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Country | US
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Telephone | 808-726-6653
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Fax | 808-378-7075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A14673
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 20A14673
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License Number State | CA
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