Provider Demographics
NPI:1154338804
Name:SAN FELIPE, ASELA R (MD)
Entity type:Individual
Prefix:
First Name:ASELA
Middle Name:R
Last Name:SAN FELIPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4700
Mailing Address - Country:US
Mailing Address - Phone:602-843-1480
Mailing Address - Fax:602-843-0168
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE #5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4700
Practice Address - Country:US
Practice Address - Phone:602-843-1480
Practice Address - Fax:602-843-0168
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ15061208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249195OtherAHCCCS