Provider Demographics
NPI:1356457790
Name:ABDO, GABY JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GABY
Middle Name:JEAN
Last Name:ABDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ARDEN AVE
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1127
Mailing Address - Country:US
Mailing Address - Phone:818-500-8466
Mailing Address - Fax:818-500-9562
Practice Address - Street 1:410 ARDEN AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1127
Practice Address - Country:US
Practice Address - Phone:818-500-8466
Practice Address - Fax:818-500-9562
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A7216OtherCA MEDICAL LICENSE
CA00AX72160Medicaid
CA20A7216OtherCA MEDICAL LICENSE
CA00AX72160Medicaid