Provider Demographics
NPI:1174507040
Name:KUBBEH, ABDALLAH VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDALLAH
Middle Name:VICTOR
Last Name:KUBBEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5606
Mailing Address - Country:US
Mailing Address - Phone:404-915-5692
Mailing Address - Fax:760-203-0027
Practice Address - Street 1:388 LOCH LOMOND RD
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5606
Practice Address - Country:US
Practice Address - Phone:404-915-5692
Practice Address - Fax:760-203-0027
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39353207RC0000X
GA021731207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD29989Medicare UPIN
CA00A393530Medicare ID - Type Unspecified