Provider Demographics
NPI:1275593816
Name:PHELPS, ALLEN MARTIN (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MARTIN
Last Name:PHELPS
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41715 WINCHESTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4853
Mailing Address - Country:US
Mailing Address - Phone:951-308-4451
Mailing Address - Fax:
Practice Address - Street 1:41715 WINCHESTER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4853
Practice Address - Country:US
Practice Address - Phone:951-308-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1056661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant