Provider Demographics
NPI:1447309281
Name:SABOGAL, MAURICIO (DO)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:SABOGAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2216
Mailing Address - Country:US
Mailing Address - Phone:704-671-6300
Mailing Address - Fax:704-671-6307
Practice Address - Street 1:705 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 150
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2216
Practice Address - Country:US
Practice Address - Phone:704-671-6300
Practice Address - Fax:704-671-6307
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO1490208000000X
NC2009-00667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics