Provider Demographics
NPI:1588848980
Name:ABIGAILS MEDICAL BOUTIQUE & SUPPLIES INC
Entity Type:Organization
Organization Name:ABIGAILS MEDICAL BOUTIQUE & SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME-VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-940-1132
Mailing Address - Street 1:449 SANTA FE DR
Mailing Address - Street 2:#330
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5134
Mailing Address - Country:US
Mailing Address - Phone:760-940-1132
Mailing Address - Fax:760-940-1166
Practice Address - Street 1:3910 VISTA WAY
Practice Address - Street 2:STE 112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4513
Practice Address - Country:US
Practice Address - Phone:760-940-1132
Practice Address - Fax:760-940-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4808610001Medicare NSC