Provider Demographics
NPI:1750799680
Name:RAISING SAGES INTEGRATIVE PEDIATRICS, INC.
Entity type:Organization
Organization Name:RAISING SAGES INTEGRATIVE PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLIEDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-788-1111
Mailing Address - Street 1:PO BOX 12257
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5057
Mailing Address - Country:US
Mailing Address - Phone:949-788-1111
Mailing Address - Fax:949-788-1110
Practice Address - Street 1:1601 DOVE ST
Practice Address - Street 2:SUITE 276
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2433
Practice Address - Country:US
Practice Address - Phone:949-788-1111
Practice Address - Fax:949-788-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76363208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty