Provider Demographics
NPI:1205968492
Name:GREELEY, ADELA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ADELA
Middle Name:MARIA
Last Name:GREELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADELITA
Other - Middle Name:MARIA
Other - Last Name:GREELEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1250 16TH ST
Mailing Address - Street 2:SUITE A454
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1249
Mailing Address - Country:US
Mailing Address - Phone:310-319-4698
Mailing Address - Fax:310-319-4908
Practice Address - Street 1:1250 16TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1249
Practice Address - Country:US
Practice Address - Phone:310-319-4698
Practice Address - Fax:310-319-4908
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86940208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205968492OtherCCS PANELED
CA1205968492Medicaid
CA1205968492Medicaid