Provider Demographics
NPI:1497043715
Name:ABOLMOLOUK, SARA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ABOLMOLOUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N PASEO DE LOS RIOS
Mailing Address - Street 2:#4205
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6051
Mailing Address - Country:US
Mailing Address - Phone:818-404-4247
Mailing Address - Fax:
Practice Address - Street 1:3300 N PASEO DE LOS RIOS
Practice Address - Street 2:4205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6051
Practice Address - Country:US
Practice Address - Phone:818-404-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine