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General NPI Number Information
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NPI Number | 1346240637
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Entity Type | Individual
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Provider Name | ELLIOT M SACKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 27700 MEDICAL CENTER RD
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6426
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Country | US
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Telephone | 949-263-8620
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Fax | 800-409-7005
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Provider Business Mailing Address
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Address Line | DEPT LA 21789
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City | PASADENA
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State | CA
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Zip | 91185-1789
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Country | US
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Telephone | 949-263-8620
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Fax | 800-409-7005
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD00028454
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G32657
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MD00028454
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | G32657
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License Number State | CA
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