Healthcare Provider Details

I. General information

NPI: 1831053420
Provider Name (Legal Business Name): MR. SABATA LUBARI RAMBA SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 W STOCKWELL CT
SALT LAKE CITY UT
84129-5902
US

IV. Provider business mailing address

2722 W STOCKWELL CT
SALT LAKE CITY UT
84129-5902
US

V. Phone/Fax

Practice location:
  • Phone: 801-674-3851
  • Fax: --
Mailing address:
  • Phone: 801-674-3851
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number166921079
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: