Provider Demographics
NPI:1972260560
Name:ABBOUD, FATIMA
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 GARDEN HOMES PL
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-9516
Mailing Address - Country:US
Mailing Address - Phone:916-793-8212
Mailing Address - Fax:
Practice Address - Street 1:4862 GARDEN HOMES PL
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-9516
Practice Address - Country:US
Practice Address - Phone:916-793-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver