Individual provider · NPI-1

Dr. Agustin Maria Abdallah, M.D.

Internal Medicine · Los Angeles, CA

NPI number1134524184
StatusActive
Last updated in NPPESNov 23, 2020

Details

NPI
1134524184
Entity type
Individual (NPI-1)
Name
Dr. Agustin Maria Abdallah
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 1, 2014
Certification date
Nov 23, 2020
Last updated
Nov 23, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine141310CAYes
208000000X Pediatrics141310CA
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

245 S Fetterly Ave
Los Angeles, CA 90022-1605

Phone 323-362-1010

Mailing address

1200 N State St
Ct-A7d
Los Angeles, CA 90033-1029

Phone 323-226-7556 · Fax 323-226-2657

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