Healthcare Provider Details

I. General information

NPI: 1629083902
Provider Name (Legal Business Name): SABRINA JABEEN HUSSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 WOODROW AVE STE B10
MODESTO CA
95350-1273
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-5628
  • Fax: 209-579-5637
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA93539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: