Provider Demographics
NPI:1316179294
Name:BARBARA A. PHELPS-SANDALL MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BARBARA A. PHELPS-SANDALL MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHELPS-SANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-988-7830
Mailing Address - Street 1:2485 HOSPITAL DR
Mailing Address - Street 2:SUITE 321
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4101
Mailing Address - Country:US
Mailing Address - Phone:650-988-7830
Mailing Address - Fax:650-966-9207
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071692207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154363448OtherTYPE I NPI
CAX77313Medicare UPIN