Provider Demographics
NPI:1336234442
Name:ABELS, ALICIA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MARIE
Last Name:ABELS
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 1:9126 RIVER LOOK LN
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6568
Mailing Address - Country:US
Mailing Address - Phone:916-863-1261
Mailing Address - Fax:
Practice Address - Street 1:1600 CREEKSIDE DRIVE
Practice Address - Street 2:SUITE 2400
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50345208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G503451Medicaid
CA00G503450Medicaid
CA00G503450Medicare ID - Type UnspecifiedDOWNTOWN OFFICE
CAA51647Medicare UPIN
CA00G503450Medicaid