Provider Demographics
NPI:1194728881
Name:SEBTI, ESMAEIL (MD)
Entity type:Individual
Prefix:DR
First Name:ESMAEIL
Middle Name:
Last Name:SEBTI
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92286-0460
Mailing Address - Country:US
Mailing Address - Phone:760-365-3711
Mailing Address - Fax:800-517-0487
Practice Address - Street 1:56970 YUCCA TRL
Practice Address - Street 2:STE 104
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3753
Practice Address - Country:US
Practice Address - Phone:760-365-3711
Practice Address - Fax:888-523-0327
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA555312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A555311Medicaid
CA00A555310Medicare ID - Type Unspecified
CAG84702Medicare UPIN