Provider Demographics
NPI:1962987644
Name:PHYLLIS E NAPOLES MD
Entity type:Organization
Organization Name:PHYLLIS E NAPOLES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAPOLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-456-4428
Mailing Address - Street 1:2800 L ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5616
Mailing Address - Country:US
Mailing Address - Phone:916-456-4428
Mailing Address - Fax:916-456-4465
Practice Address - Street 1:2800 L ST STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5616
Practice Address - Country:US
Practice Address - Phone:916-456-4428
Practice Address - Fax:916-456-4465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYLLIS NAPOLES SURGICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA116965OtherSTATE LICENSE NUMBER