Provider Demographics
NPI:1609863638
Name:ABELLERA, NILDA AGNES ABELLA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NILDA AGNES
Middle Name:ABELLA
Last Name:ABELLERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2350 MCKEE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1617
Mailing Address - Country:US
Mailing Address - Phone:408-272-0348
Mailing Address - Fax:408-272-0378
Practice Address - Street 1:2350 MCKEE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1617
Practice Address - Country:US
Practice Address - Phone:408-272-0348
Practice Address - Fax:408-272-0378
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA035884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA035884Medicaid
A27932Medicare UPIN