Provider Demographics
NPI:1710973060
Name:SABLAN, OSCAR MANGARERO (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:MANGARERO
Last Name:SABLAN
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-0306
Mailing Address - Country:US
Mailing Address - Phone:559-296-5080
Mailing Address - Fax:559-296-5011
Practice Address - Street 1:979 O ST
Practice Address - Street 2:STE B
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2220
Practice Address - Country:US
Practice Address - Phone:559-296-5080
Practice Address - Fax:559-296-5011
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03903FMedicaid
CAG45391OtherCALIFORNIA LICENSE
CA00G453910Medicare PIN
A50014Medicare UPIN