Healthcare Provider Details

I. General information

NPI: 1174396030
Provider Name (Legal Business Name): MAX TREVOR SABIDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LINCOLN AVE STE 108
NAPA CA
94558-4908
US

IV. Provider business mailing address

375 STERLING WAY
SAN RAFAEL CA
94903-5147
US

V. Phone/Fax

Practice location:
  • Phone: 415-861-0828
  • Fax:
Mailing address:
  • Phone: 415-521-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MBPLIU
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: