Healthcare Provider Details

I. General information

NPI: 1255505053
Provider Name (Legal Business Name): WISSAM JEAN HALABI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 STOCKTON BLVD. UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2221 STOCKTON BLVD. ROOM 3104 UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817-1418
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-2362
  • Fax: 214-820-7272
Mailing address:
  • Phone: 916-734-3229
  • Fax: 916-734-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number122307
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number122307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: