Provider Demographics
NPI:1821191446
Name:DAVE, SULABHA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:SULABHA
Middle Name:A
Last Name:DAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4426
Mailing Address - Country:US
Mailing Address - Phone:562-633-0836
Mailing Address - Fax:562-633-8345
Practice Address - Street 1:2440 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4426
Practice Address - Country:US
Practice Address - Phone:562-633-0836
Practice Address - Fax:562-633-8345
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C35372Medicare UPIN
CAWA30598GMedicare ID - Type Unspecified