Healthcare Provider Details

I. General information

NPI: 1003323320
Provider Name (Legal Business Name): SARAH JANE MOGEL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

215 N MARYLAND AVE UNIT 206
GLENDALE CA
91206-4755
US

V. Phone/Fax

Practice location:
  • Phone: 310-673-4660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95007316
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number767049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: