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NPI Code Detail

MEDICARE: EDMOND ABDOU MD

MEDICARE: EDMOND ABDOU MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician186698CA

General Provider Information

NPI Number : 1386225316
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDMOND ABDOU MD
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2525 BAYFRONT BLVD
Second Line :
City : HERCULES
State : CA
Zip : 94547-1609
Country : US
Telephone Number : 310-000-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2021
Last Update Date : 12/01/2025

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Directions to “ EDMOND ABDOU MD” Practice Location

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