Provider Demographics
NPI:1497778468
Name:MOHAMMAD ABUZAINEH MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MOHAMMAD ABUZAINEH MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUZAINEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-5285
Mailing Address - Street 1:PO BOX 260620
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-0620
Mailing Address - Country:US
Mailing Address - Phone:818-708-5285
Mailing Address - Fax:818-708-5491
Practice Address - Street 1:18321 CLARK STREET
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3501
Practice Address - Country:US
Practice Address - Phone:818-708-5285
Practice Address - Fax:818-708-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37792207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377921Medicaid
CA00A377920Medicaid
CAA28459Medicare UPIN
CA00A377921Medicaid
CAA37792BMedicare PIN