Provider Demographics
NPI:1811000847
Name:MOUSSAS, ADELE REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELE
Middle Name:REGINA
Last Name:MOUSSAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JEFFERSON BLVD # B
Mailing Address - Street 2:# 180
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-2350
Mailing Address - Country:US
Mailing Address - Phone:916-403-2900
Mailing Address - Fax:916-403-2999
Practice Address - Street 1:500 JEFFERSON BLVD # B
Practice Address - Street 2:# 180
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2350
Practice Address - Country:US
Practice Address - Phone:916-403-2900
Practice Address - Fax:916-403-2999
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G699240Medicare ID - Type Unspecified
F41459Medicare UPIN