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General NPI Number Information
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NPI Number | 1033582952
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Entity Type | Organization
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Legal Business Name | SAGE MEDICAL MANAGEMENT
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 460 E CARSON PLAZA DR #114
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City | CARSON
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State | CA
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Zip | 90746-3228
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Country | US
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Telephone | 310-746-5500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11694
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City | CARSON
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State | CA
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Zip | 90749-1694
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Country | US
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Telephone | 310-746-5500
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Fax |
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Authorized Official
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Title or Position | VP
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Name | MRS. GAYLE GALE
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Credential |
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Telephone | 310-746-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 80932
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License Number State | CA
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