Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | AFE25015 | CA |
NPI | 1003112913 |
---|---|
Provider Name | Dr. Therese K. Abboud |
First Address | Coronado, CA 92118 |
Second Address | Coronado, CA 92118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2011 |
Last Update Date | 10/02/2011 |