Healthcare Provider Details

I. General information

NPI: 1285894659
Provider Name (Legal Business Name): JUBRAN SAGIA DAKWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SEAVIEW AVE
VENTURA CA
93001-4241
US

IV. Provider business mailing address

3001 SEAVIEW AVE
VENTURA CA
93001-4241
US

V. Phone/Fax

Practice location:
  • Phone: 408-250-6327
  • Fax:
Mailing address:
  • Phone: 408-250-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number120417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: