Provider Demographics
NPI:1629079181
Name:AXMINSTER MEDICAL GROUP
Entity Type:Organization
Organization Name:AXMINSTER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-792-4060
Mailing Address - Street 1:20911 EARL STREET
Mailing Address - Street 2:SUITE 440
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-419-8585
Mailing Address - Fax:310-419-8553
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:STE 440
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-419-8585
Practice Address - Fax:310-419-8553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084744Medicaid
CAZZZ48652ZOtherBLUE SHIELD
CAW14422CMedicare PIN
CAGR0084744Medicaid