MEDICARE: SARAH BRIDGE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	A173119	CA

General Provider Information

NPI Number	:	1326571472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BRIDGE MD

Provider Business Mailing Address
First Line	:	1701 E CESAR E CHAVEZ AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 E CESAR E CHAVEZ AVE STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2497
Country	:	US
Telephone Number	:	323-225-4600
Fax Number	:	323-287-0050

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	07/26/2021

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Directions to “ SARAH BRIDGE MD” Practice Location

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