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
4314 W SLAUSON AVE, LOS ANGELES, CA 90043-2854
(323) 293-7171
(323) 295-7963
Mailing address
4314 W. SLAUSON AVENUE, 2ND FLOOR, LOS ANGELES, CA 90043
(310) 792-4060
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
—
GR0084740
—
CA
01
—
ZZZ17769Z
BLUE SHIELD
CA
Enumeration date
08/09/2005
Last updated
07/06/2017
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