Provider Demographics
NPI:1154538213
Name:ABOOLIAN, ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:ABOOLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1146 N CENTRAL AVE # 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2506
Mailing Address - Country:US
Mailing Address - Phone:310-888-8862
Mailing Address - Fax:310-888-8711
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1840
Practice Address - Country:US
Practice Address - Phone:310-888-8862
Practice Address - Fax:310-888-8711
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA813472086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery