Provider Demographics
NPI:1306812805
Name:SAHAGUN, OMAR SALVADOR (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:SALVADOR
Last Name:SAHAGUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ STE 1501
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4201
Practice Address - Country:US
Practice Address - Phone:310-301-6800
Practice Address - Fax:310-794-9035
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1045572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1045570Medicaid
CAAS320XMedicare PIN
CAAS320WMedicare PIN
CAAS320ZMedicare PIN
CA00A1045570Medicaid
CAAS320YMedicare PIN