Provider Demographics
NPI:1699857706
Name:ABID, MOHAMMAD A (MD FACC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:ABID
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81709 DR CARREON BLVD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-863-4666
Mailing Address - Fax:760-863-4566
Practice Address - Street 1:81709 DR CARREON BLVD
Practice Address - Street 2:SUITE A1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-4666
Practice Address - Fax:760-459-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48105207RC0000X
CAA481050207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6964926Medicaid
F27759Medicare UPIN
CA6964926Medicaid