Provider Demographics
NPI:1720840093
Name:SUBO HEALTH
Entity Type:Organization
Organization Name:SUBO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:210-254-7215
Mailing Address - Street 1:7533 S CENTER VIEW CT # 4252
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5526
Mailing Address - Country:US
Mailing Address - Phone:801-406-1245
Mailing Address - Fax:
Practice Address - Street 1:7533 S CENTER VIEW CT # 4252
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5526
Practice Address - Country:US
Practice Address - Phone:801-406-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty