Healthcare Provider Details

I. General information

NPI: 1558364224
Provider Name (Legal Business Name): XIMENA DE SABRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 BEE CAVE RD SUITE F 200
WEST LAKE HILLS TX
78746-5280
US

IV. Provider business mailing address

5656 BEE CAVE RD SUITE F 200
WEST LAKE HILLS TX
78746-5280
US

V. Phone/Fax

Practice location:
  • Phone: 512-472-4011
  • Fax: 512-472-5057
Mailing address:
  • Phone: 512-472-4011
  • Fax: 512-472-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberL7705
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: