Healthcare Provider Details

I. General information

NPI: 1184077596
Provider Name (Legal Business Name): SGL HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
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

4850 E BASELINE RD STE 118
MESA AZ
85206-4626
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3531
  • Fax: 866-764-4599
Mailing address:
  • Phone: 480-652-5928
  • Fax:

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 LACOGNATA
Title or Position: MD
Credential: MD
Phone: 480-652-5928