Provider Demographics
NPI:1639492374
Name:RATHEANY SAKBUN M.D., PLLC
Entity Type:Organization
Organization Name:RATHEANY SAKBUN M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RATHEANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKBUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-207-1718
Mailing Address - Street 1:395 N SILVERBELL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2675
Mailing Address - Country:US
Mailing Address - Phone:520-207-1718
Mailing Address - Fax:520-207-0154
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2675
Practice Address - Country:US
Practice Address - Phone:520-207-1718
Practice Address - Fax:520-207-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty