Organization Name: | SANA MEDICAL GROUP, INC. |
NPI Number: | 1194900175 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSE L VILLAGOMEZ (PRESIDENT) |
Mailing Address: | 12099 W Washington Blvd Ste 400 Los Angeles |
State: | CA US |
Postal Code: | 900665882 |
Phone Number: | 3103983803 |
Fax Number: | |
NPI Enumeration Date: | 01/08/2008 |
NPI Last Update Date: | 12/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A61283 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |