Basic Information
Provider Information
NPI: 1033558788
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SARABI
FirstName: EHSAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3003 N CENTRAL AVE
Address2: SUITE 200
City: PHOENIX
State: AZ
PostalCode: 850122902
CountryCode: US
TelephoneNumber: 6026856000
FaxNumber: 6026856002
Practice Location
Address1: 8836 N 23RD AVE
Address2: B1
City: PHOENIX
State: AZ
PostalCode: 850214185
CountryCode: US
TelephoneNumber: 6029449810
FaxNumber: 6022167040
Other Information
ProviderEnumerationDate: 06/17/2013
LastUpdateDate: 09/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XR72920AZY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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