Provider Demographics
NPI:1699081141
Name:SABLAN ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:SABLAN ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:KEKONA
Authorized Official - Last Name:SABLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-226-9476
Mailing Address - Street 1:123 W NORTH BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3420
Mailing Address - Country:US
Mailing Address - Phone:209-722-8161
Mailing Address - Fax:
Practice Address - Street 1:123 W NORTH BEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3420
Practice Address - Country:US
Practice Address - Phone:209-722-8161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11199207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty