Provider Demographics
NPI:1992754832
Name:ABESAMIS, WILFREDO R (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:R
Last Name:ABESAMIS
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 1:6386 ALVARADO CT
Mailing Address - Street 2:310
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4905
Mailing Address - Country:US
Mailing Address - Phone:619-229-5075
Mailing Address - Fax:619-287-0833
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4905
Practice Address - Country:US
Practice Address - Phone:619-229-5075
Practice Address - Fax:619-287-0833
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060886207R00000X
CAC52129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF69491Medicare UPIN