Healthcare Provider Details

I. General information

NPI: 1053015008
Provider Name (Legal Business Name): SAGE HEMATOLOGY AND ONCOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N 91ST AVE STE 101
PEORIA AZ
85381-3629
US

IV. Provider business mailing address

13943 N 91ST AVE STE 101
PEORIA AZ
85381-3629
US

V. Phone/Fax

Practice location:
  • Phone: 623-254-7271
  • Fax: 888-388-1953
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AIDA GOLNAZARIAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-254-7271