Provider Demographics
NPI:1639409048
Name:ABRAHAMS, MARLIE JEEVANI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARLIE
Middle Name:JEEVANI
Last Name:ABRAHAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARLIE
Other - Middle Name:JEEVANI
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 W CENTRAL AVE APT 69
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5778
Mailing Address - Country:US
Mailing Address - Phone:562-760-0679
Mailing Address - Fax:
Practice Address - Street 1:661 W 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2939
Practice Address - Country:US
Practice Address - Phone:714-665-9890
Practice Address - Fax:714-665-9891
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant