Healthcare Provider Details

I. General information

NPI: 1891806329
Provider Name (Legal Business Name): LILIAN SABABA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 N VERMONT AVE STE 1
LOS ANGELES CA
90029-3587
US

IV. Provider business mailing address

866 N VERMONT AVE STE 1
LOS ANGELES CA
90029-3587
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2100
  • Fax: 323-662-0078
Mailing address:
  • Phone: 323-660-2100
  • Fax: 323-662-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA48778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: