Provider Demographics
NPI:1356017321
Name:ABDOU, MARINA AWADALLA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:AWADALLA
Last Name:ABDOU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:AWADALLA
Other - Last Name:ABDOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:997 HYDE PARK CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6621
Mailing Address - Country:US
Mailing Address - Phone:951-231-7644
Mailing Address - Fax:
Practice Address - Street 1:555 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4904
Practice Address - Country:US
Practice Address - Phone:800-345-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist