Provider Demographics
NPI:1568679397
Name:SABLAN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SABLAN MEDICAL CORPORATION
Other - Org Name:SABLAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:SABLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-296-5080
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-0306
Mailing Address - Country:US
Mailing Address - Phone:559-296-5080
Mailing Address - Fax:559-296-5011
Practice Address - Street 1:979 O ST
Practice Address - Street 2:STE B
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2220
Practice Address - Country:US
Practice Address - Phone:559-296-5080
Practice Address - Fax:559-296-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45421207Q00000X, 261QR1300X
CAG45391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03903FMedicaid
CABCP03903FMedicaid
CAHAP03903FMedicaid
CARHM03903FMedicaid
CA053903Medicare Oscar/Certification