Basic Information
| Provider Information | |||||||||
| NPI: | 1700535416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAHAMSEN | ||||||||
| FirstName: | IMANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921340001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921340001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327599 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2022 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | N | Other Service Providers | Military Health Care Provider | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.