MEDICARE: DR. STEVEN RICHARD SABO MD

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	207Q00000X	Family Medicine Physician	G77124	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB234540	OTHER	CA	MEDICARE ID

General Provider Information

NPI Number	:	1639162910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN RICHARD SABO MD

Provider Business Mailing Address
First Line	:	901 OAK PARK BLVD STE 103
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3409
Country	:	US
Telephone Number	:	805-888-4744
Fax Number	:	805-457-1550

Provider Business Practice Location Address
First Line	:	901 OAK PARK BLVD STE 103
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3409
Country	:	US
Telephone Number	:	805-888-4744
Fax Number	:	805-825-3789

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/25/2022

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