Organization
AXMINSTER MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH SANDER MD (PRESIDENT)
(310) 792-4060
Entity
Organization
Contact information
Practice address
12618 HAWTHORNE BLVD., HAWTHORNE, CA 90250-2325
(310) 263-5700
Mailing address
12618 HAWTHORNE BLVD., HAWTHORNE, CA 90250-2325
(310) 263-5700
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
—
GR0084741
—
CA
01
—
ZZZ24681Z
BLUE SHIELD
CA
Enumeration date
08/23/2005
Last updated
07/21/2022
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