Provider Demographics
NPI:1104921303
Name:SATTLER, FRED R (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:R
Last Name:SATTLER
Suffix:
Gender:M
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27688207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356390009OtherGROUP NPI
CA1902846306OtherGROUP NPI
CAGR0016910OtherGROUP MEDICAID PIN
CAGR0100430OtherGROUP MEDICAL
CA00G276880OtherBLUE SHIELD
CA00G276880Medicaid
CA00G276880197OtherCAL OPTIMA
CAW11675OtherGROUP MEDICARE PIN
CAW18762OtherGROUP MEDICARE
CACE1617OtherGROUP RAILROAD MEDICARE
CAWG27688AMedicare PIN
CAW11675OtherGROUP MEDICARE PIN