Provider Demographics
NPI:1699910562
Name:LADO-ABEAL, JOSE JOAQUIN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JOAQUIN
Last Name:LADO-ABEAL
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:UC DAVIS HEALTH
Mailing Address - Street 2:4150 V STREET
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3730
Mailing Address - Fax:
Practice Address - Street 1:1620 E ROSEVILLE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3303
Practice Address - Country:US
Practice Address - Phone:916-783-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45328207RE0101X, 207R00000X
MO2018017685207RE0101X
SC85119207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200890601Medicaid
SC851199Medicaid