Healthcare Provider Details

I. General information

NPI: 1215302989
Provider Name (Legal Business Name): TAMEEM HAZEM SABRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16465 SIERRA LAKES PKWY STE 300
FONTANA CA
92336-1242
US

IV. Provider business mailing address

16465 SIERRA LAKES PKWY STE 300
FONTANA CA
92336-1242
US

V. Phone/Fax

Practice location:
  • Phone: 909-429-2864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53077
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: