Healthcare Provider Details

I. General information

NPI: 1356757603
Provider Name (Legal Business Name): ADAM BERK SACKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 GENESEE AVE STE 200
SAN DIEGO CA
92121-2113
US

IV. Provider business mailing address

200 W. ARBOR DRIVE MC: 8809
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8600
  • Fax:
Mailing address:
  • Phone: 619-543-2165
  • Fax: 619-543-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number141542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: