Healthcare Provider Details

I. General information

NPI: 1457745705
Provider Name (Legal Business Name): COURTNEY CAVANAUGH SAGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY DREW CAVANAUGH MD

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 510-428-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberA172896
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA172896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: