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General NPI Number Information
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NPI Number | 1386467561
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Entity Type | Individual
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Provider Name | SAMUEL HOWARD BABKOW FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1293 6TH ST
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City | COACHELLA
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State | CA
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Zip | 92236-1707
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Country | US
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Telephone | 760-775-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 41740 TRINITY CIR
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City | BERMUDA DUNES
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State | CA
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Zip | 92203-1274
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Country | US
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Telephone | 760-774-3571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95032701
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License Number State | CA
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