Provider Demographics
NPI:1598933467
Name:ABUTALEB, TAGHREED M (DC)
Entity Type:Individual
Prefix:DR
First Name:TAGHREED
Middle Name:M
Last Name:ABUTALEB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S BROOKHURST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4321
Mailing Address - Country:US
Mailing Address - Phone:714-533-2922
Mailing Address - Fax:714-533-2902
Practice Address - Street 1:710 S BROOKHURST ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4321
Practice Address - Country:US
Practice Address - Phone:714-533-2922
Practice Address - Fax:714-533-2902
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV05409Medicare UPIN