Provider Demographics
NPI:1740368968
Name:ABDOO, DAVID C (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:ABDOO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARDEN PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906
Mailing Address - Country:US
Mailing Address - Phone:831-443-6050
Mailing Address - Fax:831-443-6054
Practice Address - Street 1:110 HARDEN PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906
Practice Address - Country:US
Practice Address - Phone:831-443-6050
Practice Address - Fax:831-443-6054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E40820213E00000X
CARHD147705213ER0200X
CA03014213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480025858OtherMEDICARE RAILROAD
CA000E40820Medicaid
U71445Medicare UPIN
CA000E40820Medicaid