Provider Demographics
NPI:1336653211
Name:ABUHANI, SOAD M
Entity Type:Individual
Prefix:
First Name:SOAD
Middle Name:M
Last Name:ABUHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 LOS COCHES RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4609
Mailing Address - Country:US
Mailing Address - Phone:619-857-3692
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7417
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5452
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator