Healthcare Provider Details

I. General information

NPI: 1710985569
Provider Name (Legal Business Name): SABRY E BAKR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36320 INLAND VALLEY DR SUITE 207
WILDOMAR CA
92595-7512
US

IV. Provider business mailing address

36320 INLAND VALLEY DR SUITE 207
WILDOMAR CA
92595-7512
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-5446
  • Fax: 951-698-0143
Mailing address:
  • Phone: 951-698-5446
  • Fax: 951-698-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: