Provider Demographics
NPI:1407001134
Name:ROBERTO ABDELNUR M.D., INC.
Entity Type:Organization
Organization Name:ROBERTO ABDELNUR M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-353-5933
Mailing Address - Street 1:1503 N IMPERIAL AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-353-5933
Mailing Address - Fax:
Practice Address - Street 1:1503 N IMPERIAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6301
Practice Address - Country:US
Practice Address - Phone:760-353-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36085207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360850Medicaid
CAA36085Medicare PIN
CAA84851Medicare UPIN