Healthcare Provider Details

I. General information

NPI: 1871585943
Provider Name (Legal Business Name): SANDRA M CORBIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S 8TH AVE STE 101
YUMA AZ
85364-7132
US

IV. Provider business mailing address

1490 N TURQUOISE DR
FLAGSTAFF AZ
86001-1383
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-0785
  • Fax: 928-783-0634
Mailing address:
  • Phone: 928-774-5074
  • Fax: 928-779-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: