Healthcare Provider Details

I. General information

NPI: 1033558788
Provider Name (Legal Business Name): EHSAN SARABI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 N 23RD AVE B1
PHOENIX AZ
85021-4185
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 200
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-9810
  • Fax: 602-216-7040
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-685-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR72920
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: