Provider Demographics
NPI:1295206498
Name:SABILLON, KARLA PATRICIA (MEDICAL FOSTER)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:PATRICIA
Last Name:SABILLON
Suffix:
Gender:F
Credentials:MEDICAL FOSTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 THALLAR LN NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1018
Mailing Address - Country:US
Mailing Address - Phone:215-939-6991
Mailing Address - Fax:
Practice Address - Street 1:1272 THALLAR LN NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1018
Practice Address - Country:US
Practice Address - Phone:215-939-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021706500Medicaid