Provider Demographics
NPI:1649586694
Name:ANNA P ABALOS MD INC
Entity Type:Organization
Organization Name:ANNA P ABALOS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND PHYSICAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABALOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-474-1333
Mailing Address - Street 1:701 PLEASANT GROVE BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6156
Mailing Address - Country:US
Mailing Address - Phone:916-784-7700
Mailing Address - Fax:916-784-2252
Practice Address - Street 1:701 PLEASANT GROVE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6156
Practice Address - Country:US
Practice Address - Phone:916-784-7700
Practice Address - Fax:916-784-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty