Provider Demographics
NPI:1780628842
Name:ABDEL-RAHMAN, JAMAL NASER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:NASER
Last Name:ABDEL-RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 MONTE VISTA AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2236
Mailing Address - Country:US
Mailing Address - Phone:909-624-8138
Mailing Address - Fax:
Practice Address - Street 1:9645 MONTE VISTA AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2236
Practice Address - Country:US
Practice Address - Phone:909-624-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A533080Medicare ID - Type Unspecified
CAG21497Medicare UPIN