Provider Demographics
NPI:1750328951
Name:ANTELMAN-ALDRICH, ALENE (PA)
Entity Type:Individual
Prefix:
First Name:ALENE
Middle Name:
Last Name:ANTELMAN-ALDRICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 AMERICAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5712
Mailing Address - Country:US
Mailing Address - Phone:916-487-2387
Mailing Address - Fax:
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 235
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-446-3777
Practice Address - Fax:916-446-3788
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR23478Medicare UPIN
CA0PA129350Medicare ID - Type Unspecified