Provider Demographics
NPI:1811032923
Name:ADEL F. JABOUR, M.D INC
Entity Type:Organization
Organization Name:ADEL F. JABOUR, M.D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:FAHIM
Authorized Official - Last Name:JABOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-885-7905
Mailing Address - Street 1:18350 ROSCOE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4147
Mailing Address - Country:US
Mailing Address - Phone:818-885-7905
Mailing Address - Fax:818-885-1631
Practice Address - Street 1:18350 ROSCOE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4147
Practice Address - Country:US
Practice Address - Phone:818-885-7905
Practice Address - Fax:818-885-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30429OtherMEDICAL LICENSE
CA00A304290Medicaid
CA1154380301OtherINDIVIDUAL NPI NUMBER
CA00A304290Medicaid