Provider Demographics
NPI:1427463140
Name:ABRAHAM, JEAN-PHILIPPE MELILLO (MD)
Entity type:Individual
Prefix:
First Name:JEAN-PHILIPPE
Middle Name:MELILLO
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 2ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6244
Mailing Address - Country:US
Mailing Address - Phone:831-582-2100
Mailing Address - Fax:831-886-1529
Practice Address - Street 1:2930 2ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6244
Practice Address - Country:US
Practice Address - Phone:831-582-2100
Practice Address - Fax:831-886-1529
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine