Provider Demographics
NPI:1588661078
Name:MESSROBAIN, GARABED (MD)
Entity Type:Individual
Prefix:
First Name:GARABED
Middle Name:
Last Name:MESSROBAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S PALISADE DR
Mailing Address - Street 2:STE 206
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-347-9992
Mailing Address - Fax:805-614-9260
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:STE 206
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-347-9992
Practice Address - Fax:805-614-9260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27825207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C278250Medicaid
CAA33473Medicare UPIN
CA00C278250Medicaid