Provider Demographics
NPI:1336924166
Name:CHIDIMMA ABANULO, MD, LLC
Entity Type:Organization
Organization Name:CHIDIMMA ABANULO, MD, LLC
Other - Org Name:FEMME FLOR WOMEN'S PELVIC MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABANULO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-353-4925
Mailing Address - Street 1:5289 NE ELAM YOUNG PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7551
Mailing Address - Country:US
Mailing Address - Phone:404-394-0493
Mailing Address - Fax:
Practice Address - Street 1:5289 NE ELAM YOUNG PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7551
Practice Address - Country:US
Practice Address - Phone:971-353-4925
Practice Address - Fax:971-353-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty