Provider Demographics
NPI:1336128925
Name:ZABLAN, AUGUSTO AFABLE (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:AFABLE
Last Name:ZABLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-413-1752
Mailing Address - Fax:213-413-1860
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:213
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-413-1752
Practice Address - Fax:213-413-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346000Medicaid
CAA34600Medicare ID - Type UnspecifiedMEDICARE
CA00A346000Medicaid