Provider Demographics
NPI:1619479128
Name:SABIDO, MOLLY KATHRYN (PA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHRYN
Last Name:SABIDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 GREYSTONE LN APT 20
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4953
Mailing Address - Country:US
Mailing Address - Phone:585-281-4535
Mailing Address - Fax:
Practice Address - Street 1:9233 W PICO BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1385
Practice Address - Country:US
Practice Address - Phone:310-356-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61045363A00000X
NY021889363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant