Individual
SAN RABAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2946 E BANNER GATEWAY DR, GILBERT, AZ 85234-2165
(480) 256-6444
(480) 256-4734
Mailing address
2946 E BANNER GATEWAY DR, GILBERT, AZ 85234-2165
(480) 256-6444
(480) 256-3682
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
12/08/2023
Last updated
06/25/2025
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