Provider Demographics
NPI:1245281856
Name:ABITBOL, JEAN-JACQUES (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-JACQUES
Middle Name:
Last Name:ABITBOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 RUFFIN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1338
Mailing Address - Country:US
Mailing Address - Phone:858-874-2306
Mailing Address - Fax:858-874-2356
Practice Address - Street 1:7625 MESA COLLEGE DR STE 310A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5343
Practice Address - Country:US
Practice Address - Phone:858-874-2306
Practice Address - Fax:858-874-2356
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117249207XS0117X
CAG55587207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009859400Medicaid
FLHO673ZMedicare PIN
E11573Medicare UPIN