Provider Demographics
NPI:1184460107
Name:ABU EID, ABEDALLAH M (PMHNP)
Entity type:Individual
Prefix:
First Name:ABEDALLAH
Middle Name:M
Last Name:ABU EID
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 W TOWN AND COUNTRY RD APT 2327
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4636
Mailing Address - Country:US
Mailing Address - Phone:714-515-9822
Mailing Address - Fax:
Practice Address - Street 1:1235 W TOWN AND COUNTRY RD APT 2327
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4636
Practice Address - Country:US
Practice Address - Phone:714-515-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030952363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health