Provider Demographics
NPI:1841774817
Name:SABU, BLESSY (AGAC-NP)
Entity Type:Individual
Prefix:
First Name:BLESSY
Middle Name:
Last Name:SABU
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14539 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9616
Mailing Address - Country:US
Mailing Address - Phone:714-329-2868
Mailing Address - Fax:
Practice Address - Street 1:4234 RIVERWALK PKWY STE 230
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3312
Practice Address - Country:US
Practice Address - Phone:951-781-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009183363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care