Healthcare Provider Details

I. General information

NPI: 1326412016
Provider Name (Legal Business Name): DIANA LEA SABESKY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E PARK AVE #104
EL CAJON CA
92020-3988
US

IV. Provider business mailing address

8599 SKY RIM DR
LAKESIDE CA
92040-5513
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-4294
  • Fax:
Mailing address:
  • Phone: 619-459-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPT12573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: