Healthcare Provider Details

I. General information

NPI: 1134485741
Provider Name (Legal Business Name): ELIZABETH BLAKE SASSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH BLAKE MURPHY MD

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 11/27/2023
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE 805
LOS ANGELES CA
90015-3068
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 213-763-1500
  • Fax:
Mailing address:
  • Phone: 213-763-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA142146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: