Healthcare Provider Details

I. General information

NPI: 1801897368
Provider Name (Legal Business Name): AXMINSTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD SUITE 818
LOS ANGELES CA
90045-3807
US

IV. Provider business mailing address

8540 S. SEPULVEDA BLVD. SUITE 818-A
LOS ANGELES CA
90045
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-3255
  • Fax: 310-338-1276
Mailing address:
  • Phone: 310-348-3700
  • Fax: 310-531-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH SANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 310-792-4060