Healthcare Provider Details

I. General information

NPI: 1063665339
Provider Name (Legal Business Name): AARTHI SABANAYAGAM M.B.B.S,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 07/21/2022
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 MISSION ST BAY BLVD
SAN FRANCISCO CA
94105-2921
US

IV. Provider business mailing address

536 MISSION ST BAY BLVD
SAN FRANCISCO CA
94105-2921
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2873
  • Fax: 415-353-2528
Mailing address:
  • Phone: 415-353-2873
  • Fax: 415-353-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License NumberA136110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number35.131962
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA136110
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.131962
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: