Provider Demographics
NPI:1669279691
Name:SABLICH, KEVIN BRENT (NP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRENT
Last Name:SABLICH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10353 SAN DIEGO MISSION RD APT C202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2152
Mailing Address - Country:US
Mailing Address - Phone:267-709-8964
Mailing Address - Fax:
Practice Address - Street 1:435 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4307
Practice Address - Country:US
Practice Address - Phone:619-691-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034021363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care