Provider Demographics
NPI:1760912398
Name:JASON R. ABNEY, DO A CALIFORNIA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JASON R. ABNEY, DO A CALIFORNIA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-350-1133
Mailing Address - Street 1:8 FALKNER DR
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0925
Mailing Address - Country:US
Mailing Address - Phone:949-350-1133
Mailing Address - Fax:
Practice Address - Street 1:8 FALKNER DR
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694
Practice Address - Country:US
Practice Address - Phone:949-350-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10200207QH0002X
207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK335VOtherMEDICARE