MEDICARE: DR. ESMAEIL SEBTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	A55531	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194728881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESMAEIL SEBTI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 460
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92286-0460
Country	:	US
Telephone Number	:	760-365-3711
Fax Number	:	800-517-0487

Provider Business Practice Location Address
First Line	:	56970 YUCCA TRL
Second Line	:	STE 104
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-3753
Country	:	US
Telephone Number	:	760-365-3711
Fax Number	:	888-523-0327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/22/2013

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