Provider Demographics
NPI:1841406972
Name:SABOGAL TAMAYO, JUAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:SABOGAL TAMAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:305 EAST CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-737-4782
Practice Address - Street 1:501 NORTH BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9678
Practice Address - Country:US
Practice Address - Phone:559-734-1939
Practice Address - Fax:559-734-4384
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100667207V00000X
PAMT183029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology