Provider Demographics
NPI:1588127757
Name:MOUSTAPHA ABIDALI DO PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:MOUSTAPHA ABIDALI DO PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIDALI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-251-4030
Mailing Address - Street 1:12223 HIGHLAND AVE STE 106-526
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:353 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-5309
Practice Address - Country:US
Practice Address - Phone:269-145-2196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty