Provider Demographics
NPI:1841314630
Name:ABDALLAH VICTOR KUBBEH,M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ABDALLAH VICTOR KUBBEH,M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDALLAH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KUBBEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-915-5692
Mailing Address - Street 1:388 LOCH LOMOND RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5606
Mailing Address - Country:US
Mailing Address - Phone:310-257-8039
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE W-304
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-322-9562
Practice Address - Fax:760-320-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39353207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD29989Medicare UPIN