Basic Information
| Provider Information | |||||||||
| NPI: | 1730769191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | WINFORD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 BASKETFLOWER CT | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891835586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238412916 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 408 S JONES BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025028021 | ||||||||
| FaxNumber: | 8886889464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2021 | ||||||||
| LastUpdateDate: | 04/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.