Organization
AXMINSTER MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SANDER MD (PRESIDENT)
(310) 792-4060
Entity
Organization
Contact information
Practice address
505 W CENTURY BLVD, LOS ANGELES, CA 90044-4611
(323) 754-4090
(323) 754-4016
Mailing address
21311 MADRONA AVENUE, SUITE 101, TORRANCE, CA 90503
(310) 792-4060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0084743
—
CA
01
—
ZZZ48759Z
BLUE SHIELD
CA
Enumeration date
08/09/2005
Last updated
07/06/2017
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