Healthcare Provider Details

I. General information

NPI: 1144698481
Provider Name (Legal Business Name): SARGON BEBLA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE SUITE 370
MODESTO CA
95350-4500
US

IV. Provider business mailing address

1524 MCHENRY AVE STE 370
MODESTO CA
95350-4568
US

V. Phone/Fax

Practice location:
  • Phone: 315-299-8150
  • Fax: 315-299-8155
Mailing address:
  • Phone: 315-387-2176
  • Fax: 315-387-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA79656
License Number StateCA

VIII. Authorized Official

Name: MS. PAMELA A PARBUS
Title or Position: MANAGER
Credential:
Phone: 315-387-2176