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General NPI Number Information
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NPI Number | 1184077596
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Entity Type | Organization
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Legal Business Name | SGL HOLDINGS LLC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 3941 E BASELINE RD STE 102
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City | GILBERT
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State | AZ
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Zip | 85234-2750
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Country | US
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Telephone | 480-969-3531
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Fax | 866-764-4599
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Provider Business Mailing Address
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Address Line | 4850 E BASELINE RD STE 118
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City | MESA
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State | AZ
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Zip | 85206-4626
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Country | US
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Telephone | 480-652-5928
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Fax |
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Authorized Official
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Title or Position | MD
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Name | SALVATORE LACOGNATA
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Credential | MD
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Telephone | 480-652-5928
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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 |
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License Number State |
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