Provider Demographics
NPI:1033144704
Name:ABRAHAM, GIZEL AWADALLAH (MD)
Entity Type:Individual
Prefix:
First Name:GIZEL
Middle Name:AWADALLAH
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2543
Mailing Address - Country:US
Mailing Address - Phone:818-502-2181
Mailing Address - Fax:818-502-2191
Practice Address - Street 1:1510 S CENTRAL AVE STE 510
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2543
Practice Address - Country:US
Practice Address - Phone:818-502-2181
Practice Address - Fax:818-502-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A53854Medicaid