Provider Demographics
NPI:1376225201
Name:ABAD, MICHAEL ERWIN PERENA
Entity Type:Individual
Prefix:
First Name:MICHAEL ERWIN
Middle Name:PERENA
Last Name:ABAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4823
Mailing Address - Country:US
Mailing Address - Phone:562-371-5677
Mailing Address - Fax:
Practice Address - Street 1:711 11TH ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4823
Practice Address - Country:US
Practice Address - Phone:562-371-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician