MEDICARE: DR. MAZIN Q SABRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	A35229	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053368654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAZIN Q SABRI M.D.

Provider Business Mailing Address
First Line	:	4950 SAN BERNARDINO ST
Second Line	:
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:	909-625-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 SAN BERNARDINO ST
Second Line	:	SUITE 107
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:	909-625-2393
Fax Number	:	909-625-4074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	09/06/2007

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