Healthcare Provider Details

I. General information

NPI: 1487124657
Provider Name (Legal Business Name): JACLYN SABANOVICH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 BUENAVENTURA BLVD
REDDING CA
96001-3838
US

IV. Provider business mailing address

2216 BUENAVENTURA BLVD STE B
REDDING CA
96001-3838
US

V. Phone/Fax

Practice location:
  • Phone: 530-338-0002
  • Fax:
Mailing address:
  • Phone: 530-338-0002
  • Fax: 530-768-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07180575
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF07180575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: