Basic Information
| Provider Information | |||||||||
| NPI: | 1356451785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABUDAYYEH | ||||||||
| FirstName: | ISLAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LOMA LINDA UNIVERSITY | ||||||||
| Address2: | 11234 ANDERSON STREET, ROOM 4404 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | LOMA LINDA UNIVERSITY | ||||||||
| Address2: | 11234 ANDERSON STREET, ROOM 4404 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095589730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | A84032 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | A84032 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | A84032 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 137050 | 05 | AZ | MEDICAID | AZ0918200 | 01 | AZ | BCBS | OTHER |