Provider Demographics
NPI:1487803409
Name:JEAN-JACQUES ABITBOL M D A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JEAN-JACQUES ABITBOL M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN-JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:ABITBOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-874-2306
Mailing Address - Street 1:5395 RUFFIN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1338
Mailing Address - Country:US
Mailing Address - Phone:858-874-2306
Mailing Address - Fax:858-874-2356
Practice Address - Street 1:5395 RUFFIN RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1338
Practice Address - Country:US
Practice Address - Phone:858-874-2306
Practice Address - Fax:858-874-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE11573Medicare UPIN