Provider Demographics
NPI:1568526689
Name:ABBES, EDGAR A (DPM)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:A
Last Name:ABBES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DOWNEY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1405
Mailing Address - Country:US
Mailing Address - Phone:562-602-6166
Mailing Address - Fax:562-633-1530
Practice Address - Street 1:5750 DOWNEY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1405
Practice Address - Country:US
Practice Address - Phone:562-602-6166
Practice Address - Fax:562-633-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3765213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3765000Medicaid
U18765Medicare UPIN
CA4855730001Medicare NSC
CAE3765000Medicaid