MEDICARE: NNENNA ABAEZE ABAEZE

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
1	106S00000X	Behavior Technician
2	363LF0000X	Family Nurse Practitioner	95016894	CA

General Provider Information

NPI Number	:	1457820763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNENNA ABAEZE ABAEZE

Provider Business Mailing Address
First Line	:	206 N JACKSON ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4330
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	191 ARGONNE AVE STE 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3231
Country	:	US
Telephone Number	:	562-434-6007
Fax Number	:	562-856-2370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	04/22/2021

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Directions to “ NNENNA ABAEZE ABAEZE ” Practice Location

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