Organization
ABUNDANT LIFE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN NABIL TALLEUR MD (OWNER)
(805) 698-6206
Entity
Organization
Contact information
Practice address
338 E BETTERAVIA RD, SANTA MARIA, CA 93454-7846
(805) 698-6206
Mailing address
34 RIVER POINTE WAY, LODI, CA 95240-0552
(805) 698-6206
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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