Provider Demographics
NPI:1306854898
Name:ABOLA, AMY SUGGS (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:SUGGS
Last Name:ABOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16899 W BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1603
Mailing Address - Country:US
Mailing Address - Phone:858-499-2704
Mailing Address - Fax:858-521-2363
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:858-521-2388
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A549330Medicaid
CAWA54933AMedicare ID - Type Unspecified
CA00A549330Medicaid