Healthcare Provider Details

I. General information

NPI: 1962778787
Provider Name (Legal Business Name): NATHANAEL SABBAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 305
VAN NUYS CA
91405-3604
US

IV. Provider business mailing address

18034 VENTURA BLVD # 1010
ENCINO CA
91316-3516
US

V. Phone/Fax

Practice location:
  • Phone: 818-849-6858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA137422
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA137422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: