Provider Demographics
NPI:1437121605
Name:ABBAN, CECILIA WINIFRED (FNP)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:WINIFRED
Last Name:ABBAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:WINIFRED
Other - Last Name:ABBAN-DOGLOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:28402 CRISPIN DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6032
Mailing Address - Country:US
Mailing Address - Phone:951-415-4248
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT ST
Practice Address - Street 2:15272 SUMMIT AVENUE. FONTANA, CA 92336
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-0001
Practice Address - Country:US
Practice Address - Phone:626-405-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA497994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12875OtherNPFURNISHING
CAMA0891932OtherDEA
CAMA0891932OtherDEA