Provider Demographics
NPI:1063823599
Name:PRINCESS MEDICAL GROUP APC
Entity Type:Organization
Organization Name:PRINCESS MEDICAL GROUP APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABRAHAMS
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:562-923-1112
Mailing Address - Street 1:PO BOX 252125
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8977
Mailing Address - Country:US
Mailing Address - Phone:562-923-1112
Mailing Address - Fax:
Practice Address - Street 1:11525 BROOKSHIRE AVE STE 301
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4982
Practice Address - Country:US
Practice Address - Phone:562-923-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
G86496207V00000X
208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty