Provider Demographics
NPI:1316057755
Name:ABAIAN- EAGAR, AVISA (MD)
Entity type:Individual
Prefix:
First Name:AVISA
Middle Name:
Last Name:ABAIAN- EAGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8345 E CHADWICK PKWY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6476
Mailing Address - Country:US
Mailing Address - Phone:714-998-1925
Mailing Address - Fax:
Practice Address - Street 1:8345 EAST CHADWICK PARKWAY
Practice Address - Street 2:SUITE 109-D
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867
Practice Address - Country:US
Practice Address - Phone:714-998-1925
Practice Address - Fax:714-283-0489
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 86850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316057755OtherNPI