Provider Demographics
NPI:1003391996
Name:GARCIA-ESPINO, SABAS
Entity Type:Individual
Prefix:
First Name:SABAS
Middle Name:
Last Name:GARCIA-ESPINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4511
Mailing Address - Country:US
Mailing Address - Phone:620-202-0802
Mailing Address - Fax:
Practice Address - Street 1:1714 AVENUE B
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4511
Practice Address - Country:US
Practice Address - Phone:620-202-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK01-11-1884172A00000X
KSK03-37-9324172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver