Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A35229 | CA |
NPI | 1053368654 |
---|---|
Provider Name | Dr. Mazin Q Sabri |
First Address | Montclair, CA 91763-2328 |
Second Address | Montclair, CA 91763-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A352290 | (05) | CA |
A27720 | (02) | CA |