=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376665703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M. THABET KARABALA, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2007
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 N CENTER ST STE A
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95202-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-466-4222
-----------------------------------------------------
Fax | 209-466-3306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 940 N CENTER ST SUITE A
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95202-1326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-466-4222
-----------------------------------------------------
Fax | 209-466-3306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. M THABET KARABALA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 209-466-4222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A35322
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------