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General NPI Number Information
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NPI Number | 1134472418
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Entity Type | Individual
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Provider Name | AIVARAS SAJUS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 15251 NATIONAL AVE STE 203
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City | LOS GATOS
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State | CA
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Zip | 95032-2400
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Country | US
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Telephone | 619-246-2630
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720321
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City | SAN JOSE
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State | CA
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Zip | 95172-0321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT36944
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License Number State | CA
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