Provider Demographics
NPI:1811219116
Name:BISOGNO, SANDRA JEAN (MD)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:BISOGNO
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 1:135 N ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2719
Mailing Address - Country:US
Mailing Address - Phone:310-344-2500
Mailing Address - Fax:
Practice Address - Street 1:135 N ANITA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2719
Practice Address - Country:US
Practice Address - Phone:310-344-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine