Provider Demographics
NPI:1285291161
Name:ABRAMOV, SAMVEL
Entity type:Individual
Prefix:
First Name:SAMVEL
Middle Name:
Last Name:ABRAMOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 FOOTHILL BLVD # J
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2729
Mailing Address - Country:US
Mailing Address - Phone:818-476-6495
Mailing Address - Fax:
Practice Address - Street 1:6470 FOOTHILL BLVD # J
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2729
Practice Address - Country:US
Practice Address - Phone:818-476-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications