Healthcare Provider Details

I. General information

NPI: 1255610945
Provider Name (Legal Business Name): ILYA SABSOVICH M.D., M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13290 LENNOX WAY
LOS ALTOS HILLS CA
94022-3542
US

IV. Provider business mailing address

13290 LENNOX WAY
LOS ALTOS HILLS CA
94022-3542
US

V. Phone/Fax

Practice location:
  • Phone: 650-580-0939
  • Fax:
Mailing address:
  • Phone: 650-580-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA115064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA115064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: