MEDICARE: ASELA R SAN FELIPE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	15061	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	249195	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1154338804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASELA R SAN FELIPE MD

Provider Business Mailing Address
First Line	:	5422 W THUNDERBIRD RD
Second Line	:	SUITE #5
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	602-843-1480
Fax Number	:	602-843-0168

Provider Business Practice Location Address
First Line	:	5422 W THUNDERBIRD RD
Second Line	:	SUITE #5
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	602-843-1480
Fax Number	:	602-843-0168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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