Provider Demographics
NPI:1295900280
Name:ABIEMO, ADELAIDE (PAC)
Entity type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:
Last Name:ABIEMO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ESSI
Other - Middle Name:
Other - Last Name:BAKARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:205
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-275-7575
Mailing Address - Fax:310-623-6655
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:205
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-275-7575
Practice Address - Fax:310-623-6655
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant