Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A6870 | CA |
NPI | 1003807488 |
---|---|
Provider Name | Dr. Maricel V Sabado |
First Address | Tustin, CA 92780-7242 |
Second Address | San Juan Capistrano, CA 92675-1576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 15/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX68700 | (05) | CA |
G54424 | (02) | CA |