Provider Demographics
NPI:1336162759
Name:ABDISHOO, SERGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:
Last Name:ABDISHOO
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 1:601 PARKCENTER DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3522
Mailing Address - Country:US
Mailing Address - Phone:714-453-0688
Mailing Address - Fax:714-453-0691
Practice Address - Street 1:601 PARKCENTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3522
Practice Address - Country:US
Practice Address - Phone:714-453-0688
Practice Address - Fax:714-453-0691
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA854332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA384508OtherMGD HEALTH NETWORK PIN
7165847OtherAETNA BH PIN
CA00A854330Medicaid
CA00A854330Medicaid
WA85433DMedicare PIN