Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NP95011452 | CA |
NPI | 1316504590 |
---|---|
Provider Name | Adrian Sabalboro |
First Address | Colton, CA 92324-3933 |
Second Address | Colton, CA 92324-3933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2019 |
Last Update Date | 23/05/2019 |