Healthcare Provider Details

I. General information

NPI: 1215116579
Provider Name (Legal Business Name): SABYN L PARK MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MEMORIAL BLVD
KERRVILLE TX
78028-5768
US

IV. Provider business mailing address

3600 MEMORIAL BLVD
KERRVILLE TX
78028-5768
US

V. Phone/Fax

Practice location:
  • Phone: 830-896-2020
  • Fax:
Mailing address:
  • Phone: 830-896-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: