Healthcare Provider Details

I. General information

NPI: 1962618462
Provider Name (Legal Business Name): MARIO KEKONA SABLAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E YOSEMITE AVE STE 101
MERCED CA
95340-9165
US

IV. Provider business mailing address

330 E YOSEMITE AVE STE 101
MERCED CA
95340-9165
US

V. Phone/Fax

Practice location:
  • Phone: 209-349-8429
  • Fax: 209-720-0193
Mailing address:
  • Phone: 209-349-8429
  • Fax: 209-720-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number20A11199
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number20A11199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: