Provider Demographics
NPI:1598597015
Name:ABOG, INC
Entity type:Organization
Organization Name:ABOG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:OVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-392-1193
Mailing Address - Street 1:1252 TRAVIS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4840
Mailing Address - Country:US
Mailing Address - Phone:700-392-1193
Mailing Address - Fax:872-282-0576
Practice Address - Street 1:1252 TRAVIS BLVD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4840
Practice Address - Country:US
Practice Address - Phone:700-392-1193
Practice Address - Fax:872-282-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty