Provider Demographics
NPI:1801439708
Name:SEBASTIAN, SABIN (LVN)
Entity type:Individual
Prefix:
First Name:SABIN
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 MOUNTAIN CREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-8012
Mailing Address - Country:US
Mailing Address - Phone:817-709-6981
Mailing Address - Fax:
Practice Address - Street 1:4357 MOUNTAIN CREST DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-8012
Practice Address - Country:US
Practice Address - Phone:817-709-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233714164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse