Abaka LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ABAKA LLC

Practice address

4438 Viking Dr
Bossier City, LA 71111-7509

Phone

(318) 918-0015

Fax

(318) 963-0015

NPI assigned

Jul 10, 2024

Last updated

Jul 10, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roland Bernardez, MD

Title

Owner

Phone

(469) 438-8002

Specialties & licenses 1

Addresses

Tax ID family

Abaka2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Abaka LLC

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1477106524
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Alon Angelo, M.D.

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1295723955
  NPD
• Allan S Matriano Lim, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1649268590
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1043057805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 VIKING DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117509",
            "telephone_number": "318-918-0015",
            "fax_number": "318-963-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4438 VIKING DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117509",
            "telephone_number": "318-918-0015",
            "fax_number": "318-963-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABAKA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "BERNARDEZ",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-438-8002",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.