Healthcare Provider Details

I. General information

NPI: 1811667728
Provider Name (Legal Business Name): SABIR GREENWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 W OLYMPIC BLVD STE 101
LOS ANGELES CA
90064-1166
US

IV. Provider business mailing address

11943 KIOWA AVE APT 2
LOS ANGELES CA
90049-5913
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-7586
  • Fax: 310-826-4517
Mailing address:
  • Phone: 619-852-7037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number300658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: