Provider Demographics
NPI:1811667728
Name:GREENWELL, SABIR
Entity type:Individual
Prefix:
First Name:SABIR
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 CAPRICORN WAY UNIT 15
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4692
Mailing Address - Country:US
Mailing Address - Phone:619-852-7037
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 533
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4751
Practice Address - Country:US
Practice Address - Phone:310-828-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3006582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic