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Individual

ELLIOT M SACKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
27700 MEDICAL CENTER RD, MISSION VIEJO, CA 92691-6426
(949) 263-8620
(800) 409-7005
Mailing address
DEPT LA 21789, PASADENA, CA 91185-1789
(949) 263-8620
(800) 409-7005

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G32657
CA
2085R0202X
Diagnostic Radiology Physician
MD00028454
WA
2085R0204X
Vascular & Interventional Radiology Physician
G32657
CA
2085R0204X
Vascular & Interventional Radiology Physician
MD00028454
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G326570
BC/BS OF CA
CA
05
1346240637
CA
05
8126476
WA
Enumeration date
07/28/2005
Last updated
01/14/2015
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