Provider Demographics
NPI:1669938007
Name:ROWELL, SABLE DAYNELLE AMELIA
Entity type:Individual
Prefix:
First Name:SABLE
Middle Name:DAYNELLE AMELIA
Last Name:ROWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 13TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6211
Mailing Address - Country:US
Mailing Address - Phone:209-381-6874
Mailing Address - Fax:209-725-3963
Practice Address - Street 1:301 E 13TH ST STE B
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6211
Practice Address - Country:US
Practice Address - Phone:209-381-6874
Practice Address - Fax:209-725-3963
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist