Healthcare Provider Details

I. General information

NPI: 1760179261
Provider Name (Legal Business Name): JUAN CARLOS SANABRIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 200
HARBOR CITY CA
90710-2086
US

IV. Provider business mailing address

1403 LOMITA BLVD STE 200
HARBOR CITY CA
90710-2086
US

V. Phone/Fax

Practice location:
  • Phone: 310-602-2550
  • Fax: 310-326-7205
Mailing address:
  • Phone: 310-602-2550
  • Fax: 310-326-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: