Provider Demographics
NPI:1366025009
Name:SACCO, BRIGITTE (L AC)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:SACCO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 E ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2024
Mailing Address - Country:US
Mailing Address - Phone:315-569-7801
Mailing Address - Fax:
Practice Address - Street 1:444 S CEDROS AVE STE 120
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1967
Practice Address - Country:US
Practice Address - Phone:315-569-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine