Healthcare Provider Details

I. General information

NPI: 1851501258
Provider Name (Legal Business Name): ANTONIO CASINO SABAL SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 N ALLIED WAY STE 105
PHOENIX AZ
85054-3106
US

IV. Provider business mailing address

403 W CROFTON ST
CHANDLER AZ
85225-7140
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-3399
  • Fax: 480-719-3993
Mailing address:
  • Phone: 480-892-9686
  • Fax: 480-892-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number10597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: