Basic Information
| Provider Information | |||||||||
| NPI: | 1508885039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABA | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9566 S SWISS CT | ||||||||
| Address2: | |||||||||
| City: | HEREFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856159779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806099300 | ||||||||
| FaxNumber: | 4806099350 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 SIERRA PARK RD | ||||||||
| Address2: | |||||||||
| City: | MAMMOTH LAKES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935462073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609343311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 29164 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 141298 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 569014 | 05 | AZ | MEDICAID |