Healthcare Provider Details

I. General information

NPI: 1568679397
Provider Name (Legal Business Name): SABLAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 O ST STE B
FIREBAUGH CA
93622-2220
US

IV. Provider business mailing address

PO BOX 306
FIREBAUGH CA
93622-0306
US

V. Phone/Fax

Practice location:
  • Phone: 559-296-5080
  • Fax: 559-296-5011
Mailing address:
  • Phone: 559-296-5080
  • Fax: 559-296-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG45421
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG45391
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberG45421
License Number StateCA

VIII. Authorized Official

Name: OSCAR M SABLAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-296-5080