Provider Demographics
NPI:1124391941
Name:ABDIN, ELISABETH
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:ABDIN
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PLACE
Practice Address - Street 2:SUITE 1000
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6215
Practice Address - Country:US
Practice Address - Phone:530-750-5904
Practice Address - Fax:530-750-5905
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134768207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program