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General NPI Number Information
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NPI Number | 1437471067
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Entity Type | Organization
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Legal Business Name | MEREDITH SAGAN, MD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 3200 SANTA MONICA BLVD STE 204
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City | SANTA MONICA
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State | CA
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Zip | 90404-2639
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Country | US
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Telephone | 310-382-1376
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 SANTA MONICA BLVD STE 204
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City | SANTA MONICA
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State | CA
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Zip | 90404-2639
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Country | US
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Telephone | 310-382-1376
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEREDITH SAGAN
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Credential | M.D.
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Telephone | 310-614-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A67988
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License Number State | CA
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