Healthcare Provider Details

I. General information

NPI: 1427067230
Provider Name (Legal Business Name): TABASSUM SABA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

3324 E 8TH ST
LONG BEACH CA
90804-5007
US

V. Phone/Fax

Practice location:
  • Phone: 909-358-4501
  • Fax:
Mailing address:
  • Phone: 417-439-4048
  • Fax: 417-347-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0429333
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2001026587
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71377
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2001026587
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: