Provider Demographics
NPI:1518228196
Name:SABLAN, CRISPIN M
Entity Type:Individual
Prefix:MR
First Name:CRISPIN
Middle Name:M
Last Name:SABLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502708
Mailing Address - Street 2:MARIANAS BUSINESS PLAZA
Mailing Address - City:CHALAN KANOA
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-287-1267
Mailing Address - Fax:
Practice Address - Street 1:MARIANAS BUSINESS PLAZA
Practice Address - Street 2:STE 306-10
Practice Address - City:CHALAN KANOA
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-287-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU10-0045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)