Healthcare Provider Details

I. General information

NPI: 1235433756
Provider Name (Legal Business Name): ESMAT MARIE SABBAGH IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E ARIZOLA ST
DAVIS MONTHAN AFB AZ
85707-3108
US

IV. Provider business mailing address

1028 E HALCYON RD
TUCSON AZ
85719-2154
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-3104
  • Fax:
Mailing address:
  • Phone: 520-203-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: