Provider Demographics
NPI:1083240881
Name:ABABAT, VENICE
Entity Type:Individual
Prefix:
First Name:VENICE
Middle Name:
Last Name:ABABAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 LINVILLE LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6720
Mailing Address - Country:US
Mailing Address - Phone:909-835-8864
Mailing Address - Fax:
Practice Address - Street 1:1449 LINVILLE LN
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6720
Practice Address - Country:US
Practice Address - Phone:909-835-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016242363L00000X
CA846515163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner