Healthcare Provider Details

I. General information

NPI: 1437113636
Provider Name (Legal Business Name): SANDRA BEBAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S DOBSON RD B113
CHANDLER AZ
85224-5667
US

IV. Provider business mailing address

FILE 56765 LOCK BOX
LOS ANGELES CA
90074-6765
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-5020
  • Fax: 480-899-5023
Mailing address:
  • Phone: 602-406-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18834
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: