Provider Demographics
NPI:1508885039
Name:SABA, CAROLYN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
Last Name:SABA
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 1:9566 S SWISS CT
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9779
Mailing Address - Country:US
Mailing Address - Phone:480-609-9300
Mailing Address - Fax:480-609-9350
Practice Address - Street 1:85 SIERRA PARK RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-2073
Practice Address - Country:US
Practice Address - Phone:760-934-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29164207L00000X
CA141298207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569014Medicaid
AZZ66877Medicare PIN
AZH12456Medicare UPIN
AZZ153123Medicare PIN
AZ569014Medicaid