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General NPI Number Information
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NPI Number | 1750799680
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Entity Type | Organization
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Legal Business Name | RAISING SAGES INTEGRATIVE PEDIATRICS, INC.
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 1601 DOVE ST SUITE 276
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2433
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Country | US
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Telephone | 949-788-1111
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Fax | 949-788-1110
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Provider Business Mailing Address
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Address Line | PO BOX 12257
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-5057
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Country | US
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Telephone | 949-788-1111
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Fax | 949-788-1110
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DANE R. FLIEDNER
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Credential | M.D.
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Telephone | 949-788-1111
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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 | A76363
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License Number State | CA
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