Provider Demographics
NPI:1447320569
Name:MUDIT DABRAL, M.D.
Entity type:Organization
Organization Name:MUDIT DABRAL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DABRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-928-9770
Mailing Address - Street 1:1505 SHEPARD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7020
Mailing Address - Country:US
Mailing Address - Phone:805-928-9770
Mailing Address - Fax:805-928-6350
Practice Address - Street 1:1505 SHEPARD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7020
Practice Address - Country:US
Practice Address - Phone:805-928-9770
Practice Address - Fax:805-928-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40705207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09774ZOtherBLUE SHIELD OF CA GRP #
CAGR0098760Medicaid
CAZZZ09774ZOtherBLUE SHIELD OF CA GRP #
CAGR0098760Medicaid