Healthcare Provider Details

I. General information

NPI: 1720368764
Provider Name (Legal Business Name): GUIDO D ABELLERA MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S COMMERCE ST SUITE D
STOCKTON CA
95202-2837
US

IV. Provider business mailing address

123 S COMMERCE ST SUITE D
STOCKTON CA
95202-2837
US

V. Phone/Fax

Practice location:
  • Phone: 209-467-6825
  • Fax: 209-467-6827
Mailing address:
  • Phone: 209-467-6825
  • Fax: 209-467-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA338570
License Number StateCA

VIII. Authorized Official

Name: DR. GUIDO DULAY ABELLERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-467-6825