Provider Demographics
NPI:1811556103
Name:ABUTOUK, MONA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:ABUTOUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 OSOS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3619
Mailing Address - Country:US
Mailing Address - Phone:805-549-0888
Mailing Address - Fax:
Practice Address - Street 1:1235 OSOS ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3619
Practice Address - Country:US
Practice Address - Phone:805-549-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183330208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics