Healthcare Provider Details

I. General information

NPI: 1851706618
Provider Name (Legal Business Name): SAB HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N SECOND ST
GALLUP NM
87301-5227
US

IV. Provider business mailing address

400 N SECOND ST
GALLUP NM
87301-5227
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-7754
  • Fax: 505-488-2687
Mailing address:
  • Phone: 505-565-7754
  • Fax: 505-488-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number03-295268-006
License Number StateNM

VIII. Authorized Official

Name: MRS. URVASHI BHAKTA
Title or Position: OWNER
Credential:
Phone: 505-870-3212