Provider Demographics
NPI:1982648606
Name:ABDELNUR, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:ABDELNUR
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 1:1550 PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4165
Mailing Address - Country:US
Mailing Address - Phone:760-353-5934
Mailing Address - Fax:760-352-9961
Practice Address - Street 1:1550 PEPPER DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4165
Practice Address - Country:US
Practice Address - Phone:760-353-5934
Practice Address - Fax:760-352-9961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36085207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360850Medicaid
CA00A360850Medicaid
A36085Medicare ID - Type Unspecified
HA36085BMedicare ID - Type Unspecified
HA36085Medicare ID - Type Unspecified