Jose E. Abdenur, M.D.
Individual provider Active NPI Clinical Biochemical Genetics Physician · Orange, CA
NPI 1154428027 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154428027
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Biochemical Genetics Physician 207SG0202X
- License
- A83870 (CA)
- Practice address
- 455 S Main St
PSF Metabolic
Orange, CA 92868-3835 - Phone
- (714) 289-4511
- Fax
- (714) 289-4788
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111018000042 | CA | Practitioner - Pediatric Medicine |
0446422422 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A83870 | CA | MD | Clinical Biochemical Genetics Physician |
Practice roles (2 of 3)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital of Orange County | Current |
Accepting new patients | |
| Memorial Medical Group Inc | Past | Accepting new patients |
Locations
1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481
1100 W Stewart Dr
Orange, CA 92868
Phone (714) 532-8620
455 S Main St
Orange, CA 92868
Phone (714) 289-4511
Dept LA 21333
Pasadena, CA 91185
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Biochemical Genetics Physician | 207SG0202X | A83870 | CA | Yes |
Addresses
Primary practice location
455 S Main St
PSF Metabolic
Orange, CA 92868-3835
Mailing address
455 S Main St
Orange, CA 92868-3835
Phone (714) 532-8852
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A838700 | Medicaid | CA |
Other providers in Orange, CA
- Anwar Abdelhadi
- Jane Abdelhadi
- Krystal Abdelmeseeh
- Marina Osama Rafat Said Abdelmessih
- Mark Abdelnour
- Yasmin Mokhtar Abdi
- Nagina Abdiani
- Connie Abdo
- Sheila Abdolmanafi
- Aladean Abdrabbo
All providers in Orange, CA · Clinical Biochemical Genetics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.