Provider Demographics
NPI:1578638649
Name:ABDELAAL, TAHA (MD)
Entity Type:Individual
Prefix:
First Name:TAHA
Middle Name:
Last Name:ABDELAAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TAHA
Other - Middle Name:M
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8599 HAVEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-941-9955
Mailing Address - Fax:909-941-9966
Practice Address - Street 1:8599 HAVEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-941-9955
Practice Address - Fax:909-941-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92596171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92596OtherCA PHYSICIAN LICENSE