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NPI Code Detail

MEDICARE: ELLIOT M SACKS M.D.

MEDICARE: ELLIOT M SACKS M.D.
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
12085R0202XDiagnostic Radiology PhysicianMD00028454WA
22085R0202XDiagnostic Radiology PhysicianG32657CA
32085R0204XVascular & Interventional Radiology PhysicianMD00028454WA
42085R0204XVascular & Interventional Radiology PhysicianG32657CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200G326570OTHERCABC/BS OF CA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346240637
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIOT M SACKS M.D.
Provider Business Mailing Address
First Line : DEPT LA 21789
Second Line :
City : PASADENA
State : CA
Zip : 91185-1789
Country : US
Telephone Number : 949-263-8620
Fax Number : 800-409-7005
Provider Business Practice Location Address
First Line : 27700 MEDICAL CENTER RD
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-6426
Country : US
Telephone Number : 949-263-8620
Fax Number : 800-409-7005
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 01/14/2015

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Directions to “ ELLIOT M SACKS M.D.” Practice Location

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