Provider Demographics
NPI:1609426881
Name:MAQSOOD, ABIGAIL JOY
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JOY
Last Name:MAQSOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JOY
Other - Last Name:SOMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25211 STOCKPORT ST APT 209
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4952
Mailing Address - Country:US
Mailing Address - Phone:530-206-6039
Mailing Address - Fax:
Practice Address - Street 1:290A S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:415-646-6223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician