Provider Demographics
NPI:1053368654
Name:SABRI, MAZIN Q (MD)
Entity type:Individual
Prefix:DR
First Name:MAZIN
Middle Name:Q
Last Name:SABRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 SAN BERNARDINO ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2328
Mailing Address - Country:US
Mailing Address - Phone:909-625-2393
Mailing Address - Fax:
Practice Address - Street 1:4950 SAN BERNARDINO ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2328
Practice Address - Country:US
Practice Address - Phone:909-625-2393
Practice Address - Fax:909-625-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35229204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A352290Medicaid
CA00A352290Medicaid
CA00A352291Medicare ID - Type UnspecifiedMEDI-CARE MONCLAIR OFFICE
CAA27720Medicare UPIN