Provider Demographics
NPI:1598546475
Name:MOTTAHED PETERS, SABA S
Entity Type:Individual
Prefix:
First Name:SABA
Middle Name:S
Last Name:MOTTAHED PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 E RODEO DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-5999
Mailing Address - Country:US
Mailing Address - Phone:928-634-4530
Mailing Address - Fax:928-634-4532
Practice Address - Street 1:2003 E RODEO DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5999
Practice Address - Country:US
Practice Address - Phone:928-634-4530
Practice Address - Fax:928-634-4532
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO-003126156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician