Provider Demographics
NPI:1154363448
Name:PHELPS-SANDALL, BARBARA ANN (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:PHELPS-SANDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 SHANNON RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4728
Mailing Address - Country:US
Mailing Address - Phone:408-358-5057
Mailing Address - Fax:
Practice Address - Street 1:2485 HOSPITAL DR
Practice Address - Street 2:SUITE #321
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4101
Practice Address - Country:US
Practice Address - Phone:650-988-7830
Practice Address - Fax:650-966-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 071692207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10967254OtherCAQH ID NUMBER
CAX77313Medicare UPIN
CA10967254OtherCAQH ID NUMBER