Provider Demographics
NPI:1245216811
Name:PHELAN, AIDA S (MD)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:S
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1621 CREEKSIDE DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-984-7428
Mailing Address - Fax:916-984-0157
Practice Address - Street 1:1621 CREEKSIDE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-7428
Practice Address - Fax:916-984-0157
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-10-22
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Provider Licenses
StateLicense IDTaxonomies
CAA062622207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006631OtherPHYSICIAN INDEX #
CA006631OtherPHYSICIAN INDEX #
CA00A626220Medicare ID - Type Unspecified