Provider Demographics
NPI:1609097088
Name:SAGAN, MEREDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:SAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 WILSHIRE BLVD STE 1535
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5406
Mailing Address - Country:US
Mailing Address - Phone:310-614-0711
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 1222
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2612
Practice Address - Country:US
Practice Address - Phone:310-614-0711
Practice Address - Fax:310-861-0965
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA679882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH69313Medicare UPIN