Provider Demographics
NPI:1134120124
Name:ABBASI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ABBASI MEDICAL CORPORATION
Other - Org Name:GERIATRIC MEDICAL GROUP & SENIOR HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-775-7314
Mailing Address - Street 1:PO BOX 231337
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-1337
Mailing Address - Country:US
Mailing Address - Phone:858-433-4898
Mailing Address - Fax:858-433-4899
Practice Address - Street 1:4130 LA JOLLA VILLAGE DR STE 201
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1480
Practice Address - Country:US
Practice Address - Phone:858-433-4898
Practice Address - Fax:858-433-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90215207Q00000X
CAA44636207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20986Medicare PIN