Abellera Medical Group, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A35884 Issued in CA

Legal business name

ABELLERA MEDICAL GROUP, INC.

Practice address

2350 McKee Rd Ste 1
San Jose, CA 95116-1617

Phone

(408) 272-0379

NPI assigned

May 21, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nilda Agnes A Abellera, M.D.

Title

Ceo/President

Phone

(408) 272-0379

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374451200000",
    "number": "1154588515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 MCKEE RD STE 1",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 MCKEE RD STE 1",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161617",
            "telephone_number": "408-272-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABELLERA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2013-07-22",
        "status": "A",
        "authorized_official_last_name": "ABELLERA",
        "authorized_official_first_name": "NILDA AGNES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "408-272-0379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A35884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0705196",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adel Boutros Abi-Hanna, MD

• Primary Care Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.