Provider Demographics
NPI:1386229607
Name:ABDON, CONNIE VANESSA
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:VANESSA
Last Name:ABDON
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 1:19750 S. VERMONT AVE
Mailing Address - Street 2:140
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1130
Mailing Address - Country:US
Mailing Address - Phone:310-719-3908
Mailing Address - Fax:310-719-3908
Practice Address - Street 1:16903 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3338
Practice Address - Country:US
Practice Address - Phone:323-290-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician