Healthcare Provider Details

I. General information

NPI: 1598965782
Provider Name (Legal Business Name): AHMAD AL-SABBAGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 RUTHERFORD RD
CARLSBAD CA
92008-7328
US

IV. Provider business mailing address

27681 MILANO WAY
MISSION VIEJO CA
92692-4139
US

V. Phone/Fax

Practice location:
  • Phone: 760-431-6154
  • Fax:
Mailing address:
  • Phone: 617-842-5590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301090350
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA 108482
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number4301090350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: