Provider Demographics
NPI:1912545500
Name:ABDOU, NEFERTITI (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:NEFERTITI
Middle Name:
Last Name:ABDOU
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WESTHOLME AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5910
Mailing Address - Country:US
Mailing Address - Phone:424-645-9741
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BLVD STE 702
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3906
Practice Address - Country:US
Practice Address - Phone:424-645-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist