MEDICARE: DR. MAURIZIO C SANGES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC16849	CA

General Provider Information

NPI Number	:	1235202805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURIZIO C SANGES D.C.

Provider Business Mailing Address
First Line	:	2850 ARTESIA BLVD STE 208
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3413
Country	:	US
Telephone Number	:	310-370-0371
Fax Number	:	310-542-1488

Provider Business Practice Location Address
First Line	:	2850 ARTESIA BLVD STE 208
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3413
Country	:	US
Telephone Number	:	310-370-0371
Fax Number	:	310-542-1488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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