Provider Demographics
NPI:1639162910
Name:SABO, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:SABO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:STEVEN
Other - Last Name:SABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 OAK PARK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3409
Mailing Address - Country:US
Mailing Address - Phone:805-888-4744
Mailing Address - Fax:805-457-1550
Practice Address - Street 1:901 OAK PARK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3409
Practice Address - Country:US
Practice Address - Phone:805-888-4744
Practice Address - Fax:805-825-3789
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77124207Q00000X, 207PE0005X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB234540OtherMEDICARE ID