MEDICARE: AXMINSTER MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ48759Z	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538160098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXMINSTER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	21311 MADRONA AVENUE
Second Line	:	SUITE 101
City	:	TORRANCE
State	:	CA
Zip	:	90503
Country	:	US
Telephone Number	:	310-792-4060
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W CENTURY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4611
Country	:	US
Telephone Number	:	323-754-4090
Fax Number	:	323-754-4016

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH SANDER
Credential	:	MD
Telephone Number	:	310-792-4060

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/06/2017

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Directions to “AXMINSTER MEDICAL GROUP ” Practice Location

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