Healthcare Provider Details

I. General information

NPI: 1669279691
Provider Name (Legal Business Name): KEVIN BRENT SABLICH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 H ST
CHULA VISTA CA
91910-4307
US

IV. Provider business mailing address

10353 SAN DIEGO MISSION RD APT C202
SAN DIEGO CA
92108-2152
US

V. Phone/Fax

Practice location:
  • Phone: 619-691-7360
  • Fax:
Mailing address:
  • Phone: 267-709-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95034021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: