Provider Demographics
NPI:1457082190
Name:ABOUAITA, GEORGE MICHEL
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHEL
Last Name:ABOUAITA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12431 FIREFLY WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-0561
Mailing Address - Country:US
Mailing Address - Phone:818-862-1346
Mailing Address - Fax:
Practice Address - Street 1:14515 MOJAVE DR STE B
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-6762
Practice Address - Country:US
Practice Address - Phone:760-955-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167444183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician