Provider Demographics
NPI:1518279207
Name:BRUCE J SACHS MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRUCE J SACHS MD PROFESSIONAL CORPORATION
Other - Org Name:BRUCE J SACHS MD PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SACHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-944-6520
Mailing Address - Street 1:501 N EL CAMINO REAL
Mailing Address - Street 2:STE 100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1335
Mailing Address - Country:US
Mailing Address - Phone:760-944-6520
Mailing Address - Fax:760-944-6525
Practice Address - Street 1:501 N EL CAMINO REAL
Practice Address - Street 2:STE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1335
Practice Address - Country:US
Practice Address - Phone:760-944-6520
Practice Address - Fax:760-944-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADN555AMedicare PIN
A45375AMedicare PIN