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
8540 S SEPULVEDA BLVD, SUITE 818, LOS ANGELES, CA 90045-3807
(310) 670-3255
(310) 338-1276
Mailing address
8540 S. SEPULVEDA BLVD., SUITE 818-A, LOS ANGELES, CA 90045
(310) 348-3700
(310) 531-2325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0084742
—
CA
01
—
ZZZ34959Z
BLUE SHIELD
CA
Enumeration date
08/09/2005
Last updated
07/06/2017
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