Organization
ABELLERA MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NILDA AGNES A ABELLERA M.D. (CEO/PRESIDENT)
(408) 272-0379
Entity
Organization
Contact information
Practice address
2350 MCKEE RD STE 1, SAN JOSE, CA 95116-1617
(408) 272-0379
Mailing address
2350 MCKEE RD STE 1, SAN JOSE, CA 95116-1617
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A35884
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0705196
CLIA
CA
Enumeration date
05/21/2008
Last updated
07/22/2013
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