Provider Demographics
NPI:1942381793
Name:DAVID ABRAHAMSON MD INC
Entity Type:Organization
Organization Name:DAVID ABRAHAMSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:949-262-2996
Mailing Address - Street 1:PO BOX 7526
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7526
Mailing Address - Country:US
Mailing Address - Phone:949-262-2996
Mailing Address - Fax:949-715-4934
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3708
Practice Address - Country:US
Practice Address - Phone:949-262-2996
Practice Address - Fax:949-715-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43554207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060034801OtherRAILROAD MEDICARE
CA00A435540OtherCAL-OPTIMA
CAA43554OtherSTATE LICENSE
CA00A435541Medicaid
CAA43554OtherSTATE LICENSE
E47964Medicare UPIN