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General NPI Number Information
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NPI Number | 1538160098
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Entity Type | Organization
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Legal Business Name | AXMINSTER MEDICAL GROUP
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 505 W CENTURY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90044-4611
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Country | US
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Telephone | 323-754-4090
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Fax | 323-754-4016
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Provider Business Mailing Address
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Address Line | 21311 MADRONA AVENUE SUITE 101
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City | TORRANCE
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State | CA
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Zip | 90503
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Country | US
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Telephone | 310-792-4060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH SANDER
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Credential | MD
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Telephone | 310-792-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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