Provider Demographics
NPI:1104016872
Name:ABBO, JOSEF Z (MD)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:Z
Last Name:ABBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOUSSEF
Other - Middle Name:
Other - Last Name:ABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:702-233-1081
Practice Address - Street 1:5785 CENTENNIAL CENTER BLVD STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-383-6270
Practice Address - Fax:702-395-3023
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104016872OtherSMA MEDICAID
IL125053598Other125053598