Provider Demographics
NPI:1629252135
Name:SABOGAL, JENNY ISABEL
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ISABEL
Last Name:SABOGAL
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 1:1109 PINE DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7414
Mailing Address - Country:US
Mailing Address - Phone:954-689-3770
Mailing Address - Fax:
Practice Address - Street 1:4450 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5112
Practice Address - Country:US
Practice Address - Phone:954-689-3770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist