=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649586694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA P ABALOS MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2010
-----------------------------------------------------
Last Update Date | 08/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 PLEASANT GROVE BLVD SUITE 125
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-784-7700
-----------------------------------------------------
Fax | 916-784-2252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 PLEASANT GROVE BLVD SUITE 125
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95678-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-784-7700
-----------------------------------------------------
Fax | 916-784-2252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND PHYSICAN OWNER
-----------------------------------------------------
Name | ANNA P ABALOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-474-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A99301
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------