Provider Demographics
NPI:1154441061
Name:ABUASSAF, NAEEM
Entity Type:Individual
Prefix:
First Name:NAEEM
Middle Name:
Last Name:ABUASSAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FREMONT DR
Mailing Address - Street 2:P.O.BOX 3182
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-3182
Mailing Address - Country:US
Mailing Address - Phone:626-260-2959
Mailing Address - Fax:
Practice Address - Street 1:580 FOREST SHADE, SUITE 4
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-0989
Practice Address - Country:US
Practice Address - Phone:909-338-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist