MEDICARE: SABLAN ORTHOPEDICS, INC.

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	207X00000X	Orthopaedic Surgery Physician	20A11199	CA

General Provider Information

NPI Number	:	1699081141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SABLAN ORTHOPEDICS, INC.

Provider Business Mailing Address
First Line	:	123 W NORTH BEAR CREEK DR
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3420
Country	:	US
Telephone Number	:	209-722-8161
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 W NORTH BEAR CREEK DR
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3420
Country	:	US
Telephone Number	:	209-722-8161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIO KEKONA SABLAN
Credential	:	D.O.
Telephone Number	:	917-226-9476

Provider Enumeration Date	:	08/22/2010
Last Update Date	:	08/22/2010

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