Provider Demographics
NPI:1245770155
Name:DR NABIL ABUDAYEH
Entity Type:Organization
Organization Name:DR NABIL ABUDAYEH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-771-2814
Mailing Address - Street 1:20700 LAKE CHABOT RD
Mailing Address - Street 2:STE 107
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5401
Mailing Address - Country:US
Mailing Address - Phone:510-728-7961
Mailing Address - Fax:510-886-0268
Practice Address - Street 1:20700 LAKE CHABOT RD
Practice Address - Street 2:STE 107
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5401
Practice Address - Country:US
Practice Address - Phone:510-728-7961
Practice Address - Fax:510-886-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059072305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G590720OtherALAMEDA ALLIANCE