Provider Demographics
NPI:1447246293
Name:ABOELATA, NOHA MANDOUH (MD)
Entity type:Individual
Prefix:MS
First Name:NOHA
Middle Name:MANDOUH
Last Name:ABOELATA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:419 30TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3301
Mailing Address - Country:US
Mailing Address - Phone:510-451-4747
Mailing Address - Fax:510-451-0570
Practice Address - Street 1:419 30TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3301
Practice Address - Country:US
Practice Address - Phone:510-451-4747
Practice Address - Fax:510-451-0570
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA71602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16521Medicare UPIN