Individual
AIDA S. PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1621 CREEKSIDE DRIVE, SUITE 102, FOLSOM, CA 95630
(916) 984-7428
(916) 984-0157
Mailing address
1621 CREEKSIDE DRIVE, SUITE 102, FOLSOM, CA 95630
(916) 984-7428
(916) 984-0157
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A062622
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006631
PHYSICIAN INDEX #
CA
Enumeration date
12/15/2005
Last updated
10/22/2010
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