Provider Demographics
NPI:1295818565
Name:GARY L. SUGARMAN,M.D.,INC.
Entity Type:Organization
Organization Name:GARY L. SUGARMAN,M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-829-9333
Mailing Address - Street 1:25411 CABOT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5520
Mailing Address - Country:US
Mailing Address - Phone:949-829-9333
Mailing Address - Fax:949-829-9210
Practice Address - Street 1:25411 CABOT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5520
Practice Address - Country:US
Practice Address - Phone:949-829-9333
Practice Address - Fax:949-829-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81230261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81230Medicare PIN
CAF72863Medicare UPIN