1841314630 NPI number — ABDALLAH VICTOR KUBBEH,M.D. A PROFESSIONAL CORPORATION

Table of content: (NPI 1841314630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841314630 NPI number — ABDALLAH VICTOR KUBBEH,M.D. A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABDALLAH VICTOR KUBBEH,M.D. A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841314630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
388 LOCH LOMOND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-257-8039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 N INDIAN CANYON DR
Provider Second Line Business Practice Location Address:
SUITE W-304
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-322-9562
Provider Business Practice Location Address Fax Number:
760-320-4226
Provider Enumeration Date:
03/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUBBEH
Authorized Official First Name:
ABDALLAH
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-915-5692

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A39353 , 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)





Copyright © 2007-2024 www.npivalidator.com