Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A30429 | CA |
Y | 208600000X | Surgeon | A30429 | CA |
N | 2086S0129X | Vascular Surgeon | A30429 | CA |
NPI | 1154380301 |
---|---|
Provider Name | Dr. Adel F. Jabour |
First Address | Northridge, CA 91325-4109 |
Second Address | Northridge, CA 91325-4109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 27/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A304290 | (05) | CA |
A84088 | (02) | CA |