Healthcare Provider Details

I. General information

NPI: 1639186588
Provider Name (Legal Business Name): SANFORD PHILIP LYLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD #136
ANAHEIM CA
92807-4780
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD #136
ANAHEIM CA
92807-4780
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-8160
  • Fax: 714-282-7031
Mailing address:
  • Phone: 714-828-8160
  • Fax: 714-282-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG22147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: