Provider Demographics
NPI:1427395011
Name:MAZIN Q. SABRI M.D., INC.
Entity Type:Organization
Organization Name:MAZIN Q. SABRI M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-625-2393
Mailing Address - Street 1:2617 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3226
Mailing Address - Country:US
Mailing Address - Phone:714-633-8934
Mailing Address - Fax:909-625-4074
Practice Address - Street 1:2617 E CHAPMAN AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3226
Practice Address - Country:US
Practice Address - Phone:714-633-8934
Practice Address - Fax:909-625-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35229207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35229Medicare PIN