1699857706 NPI number — MOHAMMAD A ABID MD FACC

Table of content: MOHAMMAD A ABID MD FACC (NPI 1699857706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699857706 NPI number — MOHAMMAD A ABID MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABID
Provider First Name:
MOHAMMAD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699857706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81709 DR CARREON BLVD
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
INDIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-863-4666
Provider Business Mailing Address Fax Number:
760-863-4566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81709 DR CARREON BLVD
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
INDIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-863-4666
Provider Business Practice Location Address Fax Number:
760-459-0611
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A48105 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: A481050 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6964926 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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