Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD034312L | PA |
NPI | 1013074616 |
---|---|
Provider Name | Dr. Evelyn Frances Sabugo |
First Address | Philadelphia, PA 19115-2011 |
Second Address | Philadelphia, PA 19133-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0670920 | (05) | PA |
B29847 | (02) |