Provider Demographics
NPI:1255795878
Name:TABISH, SARFRAZ
Entity type:Individual
Prefix:
First Name:SARFRAZ
Middle Name:
Last Name:TABISH
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:PO BOX 8331
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95208-0331
Mailing Address - Country:US
Mailing Address - Phone:209-663-3117
Mailing Address - Fax:209-813-4979
Practice Address - Street 1:7 W ACACIA ST STE 3
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1243
Practice Address - Country:US
Practice Address - Phone:209-663-3117
Practice Address - Fax:209-813-4979
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17-00122762343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)