Healthcare Provider Details

I. General information

NPI: 1053877464
Provider Name (Legal Business Name): SGL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 E BASELINE RD STE 102
GILBERT AZ
85234-2750
US

IV. Provider business mailing address

3941 E BASELINE RD STE 102
GILBERT AZ
85234-2750
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3531
  • Fax: 866-764-4599
Mailing address:
  • Phone: 480-969-3531
  • Fax: 866-764-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SALVATORE G LACOGNATA
Title or Position: OWNER
Credential: DO
Phone: 480-969-3531