Provider Demographics
NPI:1841024940
Name:HAURY, ABIGAIL GRACE
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:GRACE
Last Name:HAURY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:GRACE
Other - Last Name:VIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 ORANGE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5501
Mailing Address - Country:US
Mailing Address - Phone:559-802-2836
Mailing Address - Fax:
Practice Address - Street 1:2650 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3439
Practice Address - Country:US
Practice Address - Phone:626-577-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program